Procedures for remitting payment to a nonparticipating ambulance provider for claims

Sec. 8.3. (a) A health plan operator that receives a clean claim for ambulance service provided to a covered individual by a nonparticipating ambulance service provider: (1) shall remit payment for the ambulance service directly to the nonparticipating ambulance service provider not more than thirty (30) days after receiving the clean claim; and (2) shall not send payment to the covered individual. (b) If a claim that a health plan operator receives for ambulance service provided to a covered individual by a nonparticipating ambulance service provider is not a clean claim, the health plan operator, not more than thirty (30) days after receiving the claim, shall: (1) remit payment for the ambulance service directly to the nonparticipating ambulance service provider; or (2) send to the nonparticipating ambulance service provider a written notice that: (A) acknowledges the date of the receipt of the claim; and (B) either: (i) states that the health plan operator is declining to pay all or part of the claim and sets forth the specific reason or reasons for declining to pay the claim in full; or (ii) states that additional information is needed to determine whether all or part of the claim is payable and specifically describes the additional information that is needed.