Title 31 — Insurance and Securities.

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…

(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…

(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…

(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…

A health insurer shall include with its annual report filed with the Commissioner a claims payment report to include the: (1) Number of claims received in the previous calendar year; (2) Number of claims denied in the previous calendar year; (3) Number of claims paid: (A) In the …

An action by a health insurer that establishes a pattern or practice of repeated violation of this chapter, as determined by the Commissioner, shall constitute a violation as provided in Chapter 22A of this title.

The Commissioner may adopt rules and regulations as necessary to implement this chapter.

(a) This chapter shall apply to any individual and group health benefits plan issued or renewed in the District of Columbia. Health insurers shall comply with this chapter on the earlier of October 16, 2002, or the effective date of the claims payment standards in section 1173 of…