Page:United States Statutes at Large Volume 100 Part 3.djvu/190

 100 STAT. 1998

vw<,^! Claims.


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PUBLIC LAW 99-509—OCT. 21, 1986

• s.; t r e a t m e n t that prevents timely payment from being m a d e on ,[•'' the claim under this title. Ui "(ii) The term 'applicable n u m b e r of calendar days' means— "(I) with respect to claims received in the 12-month 1 period beginning October 1, 1986, 30 calendar days, r "(II) with respect to claims received in the 12-month period beginning October 1, 1987, 26 calendar days, "(III) with respect to claims received in the 12-month . ' I •< period beginning October 1, 1988, 25 calendar days, and ,, "(IV) with respect to claims received in the 12-month period beginning October 1, 1989, and claims received in any succeeding 12-month period, 24 calendar days. "(C) If payment is not issued, mailed, or otherwise t r a n s m i t t e d

within the applicable number of calendar days (as defined in clause (ii) of subparagraph (B)) after a clean claim (as defined in clause (i) of such subparagraph) is received from a hospital, skilled nursing facility, home health agency, or hospice program that is not receiving payments on a periodic interim payment basis with respect to such services, interest shall be paid at the rate used for purposes of o.MQi-muH section 3902(a) of title 31, United States Code (relating to interest penalties for failure to make prompt payments) for the period beginning on the day after the required payment date and ending on the date on which payment is made.". (c) PROMPT PAYMENT OF CLAIMS UNDER PART B.—Section 1842(c) of

the Social Security Act (42 U.S.C. 1395u(c)) is amended— (1) by inserting "(1)" after "(c)", and (2) by adding at the end the following new paragraph: Contracts. "(2)(A) Each contract under this section which provides for the Claims. disbursement of funds, as described in subsection (a)(1)(B), shall provide that payment shall be issued, mailed, or otherwise transmitted with respect to not less than 95 percent of all claims submitted under this part— r,.?. "(i) which are clean claims, and .; ic-'' "(ii) for which payment is not made on a periodic interim payment basis, within the applicable number of calendar days after the date on which the claim is received. "(B) In this paragraph: "(i) The term 'clean claim' means a claim that has no defect or impropriety (including any lack of any required substantiatr/jci ing documentation) or particular circumstance requiring special treatment that prevents timely payment from being made on the claim under this part. "(ii) The term 'applicable number of calendar days' means— ^,, ,, "(I) with respect to claims received in the 12-month period beginning October 1, 1986, 30 calendar days, "(II) with respect to claims received in the 12-month period beginning October 1, 1987, 26 calendar days (or 19 calendar days with respect to claims submitted by partici; • pating physicians), "(III) with respect to claims received in the 12-month .t,. * period beginning October 1, 1988, 25 calendar days (or 18 calendar days with respect to cleiims submitted by participating physicians), and
 * . "(IV) with respect to claims received in the 12-month

^-pv.-i'. period beginning October 1, 1989, and claims received in ,, H. any succeeding 12-month period, 24 calendar days (or 17

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