Montana Code 33-22-1317. Eligible health insurer requests for reinsurance payments
33-22-1317. Eligible health insurer requests for reinsurance payments. (1) An eligible health insurer shall:
Terms Used In Montana Code 33-22-1317
- Association: means the Montana reinsurance association provided for in this part. See Montana Code 33-22-1303
- Board: means the association's board of directors provided for in 33-22-1306. See Montana Code 33-22-1303
- Eligible health insurer: means a health insurer, health service corporation, or health maintenance organization that:
(a)offers individual health insurance coverage in the individual market, as defined in 33-22-140;
(b)offers a qualified health plan as defined in 42 U. See Montana Code 33-22-1303
- Program: means the Montana reinsurance program operated by the Montana reinsurance association. See Montana Code 33-22-1303
- Reinsurance payments: means an amount paid by the association to an eligible health insurer under the program. See Montana Code 33-22-1303
- State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See Montana Code 1-1-201
(a)make requests for reinsurance payment in accordance with any requirements established by the board;
(b)provide the association with access to data according to the rules and timeline established by the board in the plan of operation or by the commissioner in the administrative rules. The data environment utilized must be compatible with the federal risk adjustment program.
(c)maintain documents and records sufficient to substantiate the requests for reinsurance payments made pursuant to this part for a period of at least 6 years;
(d)apply all managed care, utilization review, case management, preferred provider arrangements, claims processing, and other methods of operation as appropriate to each claim without regard to whether that claim is eligible for or may be paid by reinsurance;
(e)make records available upon request from the commissioner or the board for purposes of verification, investigation, audit, or other review of reinsurance payment requests; and
(f)repay to the reinsurance program account in the state special revenue fund any reinsurance overpayments as determined by the commissioner as a result of an investigation, audit, or other review.
(2)Data collected from eligible health insurers under this section is confidential and not subject to public inspection.