§ 27-20.10-6 - Unauthorized access to provider network contracts. - Rhode Island Statutes

SECTION 27-20.10-6

   § 27-20.10-6  Unauthorized access toprovider network contracts. – (a) It is an unfair insurance practice for the purposes of chapter 27-29 of theRhode Island general laws to knowingly access or utilize a provider'scontractual discount pursuant to a provider network contract without acontractual relationship with the provider, contracting entity, or third-party,as specified in this chapter;

   (b) Contracting entities and third-parties are obligated tocomply with subdivisions 27-20.10-4(b)(2) or 27-20.10-5(c)(1) and (2)concerning the services referenced on a remittance advice (RA) or explanationof payment (EOP). A provider may refuse the discount taken on the (RA) or (EOP)if the discount is taken without a contractual basis or in violation of thesesections. However, an error in the (RA) or (EOP) may be corrected within thirty(30) days following notice by the provider.

   (c) A contracting entity may not lease, rent, or otherwisegrant to a third-party, access to a provider network contract unless thethird-party accessing the health care contract is:

   (1) A payer or third-party administrator or another entitythat administers or processes claims on behalf of the payer;

   (2) A preferred provider organization or preferred providernetwork, including a physician organization or physician-hospital organization;or

   (3) An entity engaged in the electronic claims transportbetween the contracting entity and the payer that does not provide access tothe provider's services and discount to any other third-party.