Special Rules and Procedures Regarding the Application of the Act to the State Employee's Group Insurance Program

Section 900 Section 900.130  Special Rules and Procedures Regarding the Application of the Act to the State Employee's Group Insurance Program For claims for payment related to the State Employee's Group Insurance Program the following applies: a)         Late payment interest pertaining to health care payments may be made to and requested by a: 1)         Member – any person who receives benefits through the State Employees Group Insurance Act program and whose benefits are paid through the Health Insurance Reserve Fund. 2)         Vendor – any provider of health care to a member. b)         The Date of Approval shall be the date the Department of Central Management Services approves the bill.  The approval date given by an Administrative Services Organization (ASO) is not approval for purposes of determining whether a payment is late. c)         The Date of Payment of the claim to the member or Vendor shall be the later of the date on the check or the date DCMS instructs a claims administrator to make the payment; ordinarily, this date is referred to as the date the payment has been released. d)         A request for interest must contain the following information to be processed: 1)         An Explanation of Benefits Form from the State's Administrative Services Organization.  A duplicate is available from the ASO if needed; or 2)         Name of employee/member and claimant Social Security number Date of Service Amount of claim Claim control number e)         Interest shall be payable only to the designated payee indicated on the claim.  Ordinarily, the payee is the Vendor; however: 1)         if the payment of the claim has not been assigned to the Vendor by the member, interest may be requested by and paid to the member; 2)         if the Vendor is designated as the payee on the claim, the Vendor is entitled to any interest penalty due by the Act and the Vendor shall not charge the member interest on any unpaid balance of the claim; 3)         if payment of the claim is to be paid directly to the Vendor, and the member has paid any or all of the claim in advance of payment to the Vendor, the Vendor shall not charge the State or the member any late payment interest after the date the member made payment and shall so certify on its request for interest.