Year: 2010
Resolution Number: 38
Action Taken: Approved
Status:
Author(s): Alan M. Mindlin MD, and John Y. Koh MD
Sponsor: Alan M. Mindlin, MD, and John Y. Kohn, MD
On behalf of: Oakland County Delegation
Committee: B (Legislation)
Resolved Section(s):
RESOLVED: That MSMS seek legislation that mandates all insurance carriers who insure any Michigan citizen who have automated messages that state “no prior authorization is required if done as an outpatient” be mandated to pay the claim as a clean claim; and be it furtherRESOLVED: That MSMS seek legislation that mandates insurance carriers who insure any Michigan citizen be mandated to pay as clean claims those claims that have an authorization number on file.RATIONALE: The Committee concurred that the ability of the insurance companies to require prior authorization should not then be able to be used as an excuse to delay payment. There are some concerns about the ultimate authority of the Michigan legislature to regulate insurers from other states; however, the Committee believed that MSMS should pursue this matter as it is clearly an abusive practice by insurers.
RESOLVED: That MSMS seek legislation that mandates all insurance carriers who insure any Michigan citizen who have automated messages that state “no prior authorization is required if done as an outpatient” be mandated to pay the claim as a clean claim; and be it furtherRESOLVED: That MSMS seek legislation that mandates insurance carriers who insure any Michigan citizen be mandated to pay as clean claims those claims that have an authorization number on file.RATIONALE: The Committee concurred that the ability of the insurance companies to require prior authorization should not then be able to be used as an excuse to delay payment. There are some concerns about the ultimate authority of the Michigan legislature to regulate insurers from other states; however, the Committee believed that MSMS should pursue this matter as it is clearly an abusive practice by insurers.
Fiscal Note: NULL
Resolution: View PDF for Payment of Claims with Prior Authorization on File