Kansas Administrative Regulations

Agency 40.  Insurance Department

Article 4.  Accident and Health Insurance

 

40-4-40 Accident and sickness insurance; claim forms; acceptance required.

 

(a) As used in this regulation:

(1)  ``Commissioner'' means the commissioner of insurance, state of Kansas.

(2)  ``Claim form'' shall mean any of the forms devised and promulgated by the commissioner pursuant to K.S.A. 1991 Supp. 40-2253.

(3)  ``Insurer'' means insurance companies, health maintenance organizations, mutual non-profit medical and hospital service corporations, nonprofit dental service corporations, nonprofit optometric service corporations and nonprofit pharmacy service corporations.

(b)  Insurers transacting business in this state shall accept and process any claim for benefits designated and submitted on a claim form as defined in subsection (a) of this regulation.

(c)  Insurers shall not require health care providers, insureds or other persons to utilize a claim form promulgated by the commissioner if a simplified form will produce the information necessary to process the claim.

(d)  This regulation does not prohibit an insurer from requesting additional information from a health care provider when such information is essential to a proper determination of benefit payments.

(e)  Claim forms may be modified as necessary to accommodate the transmission and administration of claims by electronic means.

(f)  The requirements imposed by this regulation shall take effect and be in force from and after 180 days following the regulation's effective date.


(Authorized by K.S.A. 40-103; implementing K.S.A. 1991 Supp. 40-2253; effective Jan. 4, 1993.)