House unanimously approves bill to expedite insurance payments to providers.
By THE STAR STAFF
The island House of Representatives unanimously approved (48-0) a measure filed by Speaker Carlos “Johnny” Méndez Nuñez which establishes, for the first time in history, that every health service provider will receive the corresponding payment from the moment they deliver all the documents required by the insurer for the contract.
House Bill 40, part of Méndez’s legislative program, establishes the “Summary Contracting of Health Service Providers Act,” in order to establish a summary process in the contracting of health service professionals and institutions by health plan insurers.
“Puerto Rico continues to experience a massive exodus of our healthcare professionals at an accelerated and alarming rate,” the legislative leader said. “Part of the crisis stems from the difficulty physicians face in having their credentials recognized by insurance companies so they can be compensated for services rendered. When a healthcare professional or institution submits their credentials to contract with an insurer, they receive no compensation for services rendered during the process. This forces physicians to make a choice: not treat the patient or not receive payment for their services.”
“If a healthcare professional does not meet the criteria of the contract with a health insurance company and the application is denied,” Méndez added, “the insurer will not be obligated to pay for the services rendered during the evaluation. However, if the professional meets the criteria of the contract with an insurer and the application is approved, the insurer must pay for the services rendered during the evaluation, from the moment the person met the criteria.”
“This reduces the potential conflict of interest of a health plan insurer delaying the credentialing process in order to reduce payment for services rendered while the application is being evaluated,” he added.
The legislation delegates to the insurance commissioner the implementation of the law and ensuring its faithful and strict compliance.
The credentialing and contracting processes under the Traditional Medicare and Medicare Advantage programs, which are governed by federal regulations, are excluded from the application of this new law.
