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94 chapters · 1,017 sections in this title.
D.C. Code § 31-3131 Definitions
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For the purposes of this chapter, the term: (1) “Clean claim” means a claim that has no material defect or impropriety, including any lack of reasonably required substantiating documentation, which substantially prevents timely payment from being made on the claim or with respect…
D.C. Code § 31-3132 Prompt payment
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(a) For covered services rendered to its members, a health insurer shall reimburse any person entitled to reimbursement under the health benefits plan within 30 days after the receipt of a clean claim. (b) If a health insurer fails to comply with subsection (a) of this section, t…
D.C. Code § 31-3133 Retroactive denial of reimbursement
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(a) A health insurer may only retroactively deny reimbursement to a health care provider: (1) For services subject to coordination of benefits with another health insurer during the 18-month period after the date that the health insurer paid the health care provider; or (2) Excep…
D.C. Code § 31-3134 Provider panels
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(a) Except for Medicaid and Medicare provider panels, if a provider panel contract between a provider and a health insurer, or other entity that provides hospital, physician, or other health care services to a health insurer, require a provider, as a condition of participating in…
