(a) This section shall apply to all claims for healthcare services that are submitted as part of group or blanket health insurance contracts. (b) For purposes of this section: (1) "Carrier" means any entity that provides health insurance in this State. "Carrier" includes an insurance company, health service corporation, health maintenance organization, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation. "Carrier" also includes any third-party administrator or other entity that adjusts, administers, or settles claims in connection with health benefit plans. (2) "Carrier" does not mean an entity that provides a plan of health insurance or health benefits designed for issuance to persons eligible for coverage under Titles XVIII, XIX, and XXI of the Social Security Act (42 U.S.C. §§ 1395 et seq., 1396 et seq. and 1397 et seq.), known as Medicare, Medicaid, or any other similar coverage under state or federal governmental plans. (c) A carrier shall accept primary and secondary claims electronically from providers regardless of network status. (d) A carrier shall permit a provider to receive electronic remittance advice (ERA/835) files for claims payments upon the completion of the necessary agreements required by the carrier. (e) Any electronic claim shall be acknowledged by the carrier electronically no later than 2 business days following receipt of the claim to the entity submitting the claim.
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