376.427. Assignment of benefits made by insured to provider--payment, how made--exceptions--all claims to be paid, when.

MISSOURI STATUTES AND CODES

376.427. Assignment of benefits made by insured to provider--payment, how made--exceptions--all claims to be paid, when.

Assignment of benefits made by insured to provider--payment, howmade--exceptions--all claims to be paid, when.

376.427. 1. As used in this section, the following termsmean:

(1) "Health care services", medical, surgical, dental,podiatric, pharmaceutical, chiropractic, licensed ambulanceservice, and optometric services;

(2) "Insured", any person entitled to benefits under acontract of accident and sickness insurance, or medical-paymentinsurance issued as a supplement to liability insurance but notincluding any other coverages contained in a liability or aworkers' compensation policy, issued by an insurer;

(3) "Insurer", any person, reciprocal exchange,interinsurer, fraternal benefit society, health servicescorporation, self-insured group arrangement to the extent notprohibited by federal law, or any other legal entity engaged inthe business of insurance;

(4) "Provider", a physician, hospital, dentist, podiatrist,chiropractor, pharmacy, licensed ambulance service, oroptometrist, licensed by this state.

2. Upon receipt of an assignment of benefits made by theinsured to a provider, the insurer shall issue the instrument ofpayment for a claim for payment for health care services in thename of the provider. All claims shall be paid within thirtydays of the receipt by the insurer of all documents reasonablyneeded to determine the claim.

3. Nothing in this section shall preclude an insurer fromvoluntarily issuing an instrument of payment in the single nameof the provider.

4. This section shall not require any insurer, healthservices corporation, health maintenance corporation or preferredprovider organization which directly contracts with certainmembers of a class of providers for the delivery of health careservices to issue payment as provided pursuant to this section tothose members of the class which do not have a contract with theinsurer.