Legal/Insurance Information

73-25-37. Liability of physician, dentist, nurse, emergency medical technician, etc., for rendering emergency care; immunity from civil liability for good faith use of automated external defibrillator by person untrained in its use; immunity from civil liability for good faith use of auto-injectable epinephrine by trained school personnel  

 (1) No duly licensed, practicing physician, physician assistant, dentist, registered nurse, licensed practical nurse, certified registered emergency medical technician, or any other person who, in good faith and in the exercise of reasonable care, renders emergency care to any injured person at the scene of an emergency, or in transporting the injured person to a point where medical assistance can be reasonably expected, shall be liable for any civil damages to the injured person as a result of any acts committed in good faith and in the exercise of reasonable care or omissions in good faith and in the exercise of reasonable care by such persons in rendering the emergency care to the injured person.

(2) (a) Any person who in good faith, with or without compensation, renders emergency care or treatment by the use of an Automated External Defibrillator (AED) in accordance with the provisions of Sections 41-60-31 through 41-60-35, as well as the person responsible for the site where the AED is located if the person has provided for compliance with the provisions of Sections 41-60-31 through 41-60-35, shall be immune from civil liability for any personal injury as a result of that care or treatment, or as a result of any act, or failure to act, in providing or arranging further medical treatment, where the person acts as an ordinary, reasonably prudent person would have acted under the same or similar circumstances and the person's actions or failure to act does not amount to willful or wanton misconduct or gross negligence.

   (b) A person who has not complied with the provisions of Sections 41-60-31 through 41-60-35, but who has access to an AED and uses it in good faith in an emergency as an ordinary prudent person would have done in the same or similar circumstances, shall be immune from civil liability for any personal injury as a result of an act or omission related to the operation of or failure to operate an AED if the person's actions or failure to act do not amount to willful or wanton misconduct or gross negligence.

(3) Any employee of a local public school district, a private school, or parochial school, trained in the administration of auto-injectable epinephrine, who provides, administers, or assists in the administration of auto-injectable epinephrine, in accordance with the provisions of Section 37-11-71, to a student believed in good faith to be having an anaphylactic reaction, shall be immune from civil liability for any personal injury as a result of that care or treatment if the employee's actions or failure to act do not amount to willful or wanton misconduct or gross negligence.

(4) The immunity from civil liability for any personal injury under subsection (2) of this section includes the licensed physician who authorizes, directs or supervises the installation or provision of AED equipment in or on any premises or conveyance other than a medical facility, the owner of the premises where an AED is used, the purchaser of the AED, a person who uses an AED during an emergency for the purpose of attempting to save the life of another person who is or who appears to be in cardiac arrest, and the person who provides the CPR and AED training.

(5) The immunity from civil liability for any personal injury under subsection (3) of this section includes the licensed physician who prescribes the auto-injectable epinephrine, the school district, or any other entity, that legally obtained the auto-injectable epinephrine, and the person who provides the training in the administration of auto-injectable epinephrine.

(6) The immunity from civil liability under subsection (2) and subsection (3) of this section does not apply if the personal injury results from the gross negligence or willful or wanton misconduct of the person rendering the emergency care.

HISTORY: SOURCES: Codes, 1942, § 8893.5; Laws, 1962, ch. 413; Laws, 1964, ch. 431; Laws, 1975, ch. 329; Laws, 1976, ch. 405; Laws, 1979, ch. 376, § 1; Laws, 1999, ch. 489, § 4; Laws, 2007, ch. 428, § 1; Laws, 2014, ch. 464, § 2, eff from and after July 1, 2014. 

83-9-5. Policy provisions. 
……….
 (h) A provision as follows:

Time of payment of claims:

      1. All benefits payable under this policy for any loss, other than loss for which this policy provides any periodic payment, will be paid within twenty-five (25) days after receipt of due written proof of such loss in the form of a clean claim where claims are submitted electronically, and will be paid within thirty-five (35) days after receipt of due written proof of such loss in the form of clean claim where claims are submitted in paper format. Benefits due under the policies and claims are overdue if not paid within twenty-five (25) days or thirty-five (35) days, whichever is applicable, after the insurer receives a clean claim containing necessary medical information and other information essential for the insurer to administer preexisting condition, coordination of benefits and subrogation provisions. A "clean claim" means a claim received by an insurer for adjudication and which requires no further information, adjustment or alteration by the provider of the services or the insured in order to be processed and paid by the insurer. A claim is clean if it has no defect or impropriety, including any lack of substantiating documentation, or particular circumstance requiring special treatment that prevents timely payment from being made on the claim under this provision. A clean claim includes resubmitted claims with previously identified deficiencies corrected.

   A clean claim does not include any of the following:

         a. A duplicate claim, which means an original claim and its duplicate when the duplicate is filed within thirty (30) days of the original claim;

         b. Claims which are submitted fraudulently or that are based upon material misrepresentations;

         c. Claims that require information essential for the insurer to administer preexisting condition, coordination of benefits or subrogation provisions; or

         d. Claims submitted by a provider more than thirty (30) days after the date of service; if the provider does not submit the claim on behalf of the insured, then a claim is not clean when submitted more than thirty (30) days after the date of billing by the provider to the insured.

   Not later than twenty-five (25) days after the date the insurer actually receives an electronic claim, the insurer shall pay the appropriate benefit in full, or any portion of the claim that is clean, and notify the provider (where the claim is owed to the provider) or the insured (where the claim is owed to the insured) of the reasons why the claim or portion thereof is not clean and will not be paid and what substantiating documentation and information is required to adjudicate the claim as clean. Not later than thirty-five (35) days after the date the insurer actually receives a paper claim, the insurer shall pay the appropriate benefit in full, or any portion of the claim that is clean, and notify the provider (where the claim is owed to the provider) or the insured (where the claim is owed to the insured) of the reasons why the claim or portion thereof is not clean and will not be paid and what substantiating documentation and information is required to adjudicate the claim as clean. Any claim or portion thereof resubmitted with the supporting documentation and information requested by the insurer shall be paid within twenty (20) days after receipt.

   For purposes of this provision, the term "pay" means that the insurer shall either send cash or a cash equivalent by United States mail, or send cash or a cash equivalent by other means such as electronic transfer, in full satisfaction of the appropriate benefit due the provider (where the claim is owed to the provider) or the insured (where the claim is owed to the insured). To calculate the extent to which any benefits are overdue, payment shall be treated as made on the date a draft or other valid instrument was placed in the United States mail to the last known address of the provider (where the claim is owed to the provider) or the insured (where the claim is owed to the insured) in a properly addressed, postpaid envelope, or, if not so posted, or not sent by United States mail, on the date of delivery of payment to the provider or insured.

      2. Subject to due written proof of loss, all accrued benefits for loss for which this policy provides periodic payment will be paid            (insert period for payment which must not be less frequently than monthly), and any balance remaining unpaid upon the termination of liability will be paid within thirty (30) days after receipt of due written proof.

      3. If the claim is not denied for valid and proper reasons by the end of the applicable time period prescribed in this provision, the insurer must pay the provider (where the claim is owed to the provider) or the insured (where the claim is owed to the insured) interest on accrued benefits at the rate of one and one-half percent (1-1/2%) per month accruing from the day after payment was due on the amount of the benefits that remain unpaid until the claim is finally settled or adjudicated. Whenever interest due pursuant to this provision is less than One Dollar ($ 1.00), such amount shall be credited to the account of the person or entity to whom such amount is owed.

      4. In the event the insurer fails to pay benefits when due, the person entitled to such benefits may bring action to recover such benefits, any interest which may accrue as provided in paragraph (h)3 of this subsection and any other damages as may be allowable by law 

HISTORY: SOURCES: Codes, 1942, § 5687-03; Laws, 1956, ch. 330, § 3; Laws, 1989, ch. 466, § 1; Laws, 1991, ch. 474, § 2; Laws, 2002, ch. 575, § 1; Laws, 2013, ch. 302, § 2; brought forward without change, Laws, 2014, ch. 404, § 2, eff from and after July 1, 2014.

83-9-32. Coverage for medical benefits when dental care provided under physician-supervised anesthesia 

   Every hospital, health or medical expenses insurance policy, hospital or medical service contract, health maintenance organization and preferred provider organization that is delivered or issued for delivery in this state and otherwise provides anesthesia benefits shall offer benefits for anesthesia and for associated facility charges when the mental or physical condition of the child or mentally handicapped adult requires dental treatment to be rendered under physician-supervised general anesthesia in a hospital setting, surgical center or dental office. This coverage shall be offered on an optional basis, and each primary insured must accept or reject such coverage in writing and accept responsibility for premium payment.
 
   An insurer may require prior authorization for the anesthesia and associated facility charges for dental care procedures in the same manner that prior authorization is required for treatment of other medical conditions under general anesthesia. An insurer may require review for medical necessity and may limit payment of facility charges to certified facilities in the same manner that medical review is required and payment of facility charges is limited for other services. The benefit provided by this coverage shall be subject to the same annual deductibles or coinsurance established for all other covered benefits within a given policy, plan or contract. Private third party payers may not reduce or eliminate coverage due to these requirements.
 
   A dentist shall consider the Indications for General Anesthesia as published in the reference manual of the American Academy of Pediatric Dentistry as utilization standards for determining whether performing dental procedures necessary to treat the particular condition or conditions of the patient under general anesthesia constitutes appropriate treatment.
 
   The provisions of this section shall apply to anesthesia services provided by oral and maxillofacial surgeons as permitted by the Mississippi State Board of Dental Examiners.
 
   The provisions of this section shall not apply to treatment rendered for temporal mandibular joint (TMJ) disorders.

HISTORY: SOURCES: Laws, 1999, ch. 528, § 1, eff from and after July 1, 1999.

83-41-209. Beneficiaries' freedom of choice of practitioner in performance of dental services 

   Whenever any policy of insurance or any medical service plan or hospital service contract or hospital and medical service contract issued in this state provides for reimbursement for any service which is within the lawful scope of practice of a duly licensed dentist, as defined by the laws of the State of Mississippi, the insured, or other person entitled to benefits under such policy, shall be entitled to reimbursement for such services, whether such services are performed by a duly licensed physician or by a duly licensed dentist, notwithstanding any provision to the contrary in any statute or in such policy, plan or contract; duly licensed dentists shall be entitled to participate in such policies, plans or contracts providing for dental services, as authorized by the laws of the State of Mississippi.

HISTORY: SOURCES: Laws, 1974, ch. 406, eff from and after passage (approved March 25, 1974).

83-41-219. Reciprocal time limitations on health insurance claim filing and claim audits; applicability [See Editor's Note for effective date and applicability] 


   (1) If any health insurance issuer or other health insurance benefit payer limits the time in which a health care provider or other person is required to submit a claim for payment, the health insurance issuer or other health insurance benefit payer shall have the same time limit following payment of the claim to perform any review or audit for reconsidering the validity of the claim and requesting reimbursement for payment of an invalid claim or overpayment of a claim.

(2) If any health insurance issuer or other health insurance benefit payer does not limit the time in which a health care provider or other person is required to submit a claim for payment, the health insurance issuer or other health insurance benefit payer may not request reimbursement or offset another claim payment for reimbursement of an invalid claim or overpayment of a claim more than twelve (12) months after the payment of an invalid or overpaid claim.

(3) Nothing in this section shall apply to:

   (a) Audits that were opened before July 1, 2012;

   (b) Audits of pharmacies as provided in Section 73-21-175 et seq.;

   (c) Claims submitted by providers for reimbursement under the Mississippi Medicaid Program, except that all audits of claims and payments made by or on behalf of the Division of Medicaid are limited to a maximum of five (5) years after final filing of the claim; and

   (d) Claims submitted in the context of misrepresentation, omission, concealment, or fraud by the health care provider or other person.

HISTORY: SOURCES: Laws, 2010, ch. 393, § 1; Laws, 2012, ch. 532, § 1, eff from and after July 1, 2012. 

83-51-3. Provisions prohibited in health insurance policies and employee benefit plans 

   No health insurance policy or employee benefit plan which is delivered, renewed, issued for delivery, or otherwise contracted for in this state shall:

   (a) Prevent any person who is a party to or beneficiary of any such health insurance policy or employee benefit plan from selecting the dentist of his choice to furnish the dental care services offered by such policy or plan, or interfere with such selection, provided the dentist selected is licensed to furnish such dental care services in this state;

   (b) Deny any dentist the right to participate as a contracting provider for such policy or plan, provided the dentist is licensed to furnish the dental care services offered by such policy or plan;

   (c) Authorize any person to regulate, interfere or intervene in any manner in the diagnosis or treatment rendered by a dentist to his patient for the purpose of preventing, alleviating, curing or healing dental illness or injury, provided such dentist practices within the scope of his license; or

   (d) Require that any dentist furnishing dental care services make or obtain dental x-rays or any other diagnostic aids for the purpose of preventing, alleviating, curing or healing dental illness or injury; provided, however, that nothing herein shall prohibit requests for existing dental x-rays or any other existing diagnostic aids for the purpose of determining benefits payable under a health insurance policy or employee benefit plan.
 
   Nothing in this chapter shall prohibit the predetermination of benefits for dental care expenses prior to treatment by the attending dentist.

HISTORY: SOURCES: Laws, 1985, ch. 369, § 2, eff from and after July 1, 1985. 

83-51-5. Disclosure requirements; payments to non-contracting providers 

   Any health insurance policy or employee benefit plan which is delivered, renewed, issued for delivery, or otherwise contracted for in this state shall, to the extent that it provides benefits for dental care expenses:

   (a) Disclose, if applicable, that the benefit offered is limited to the least costly treatment;

   (b) Define and explain the standard upon which the payment of benefits or reimbursement for the cost of dental care services is based, such as "usual and customary," "reasonable and customary," "usual, customary and reasonable," or fees or words of similar import, or it shall specify in dollars and cents the amount of the payment or reimbursement for dental care services to be provided. Payment or reimbursement for a non-contracting provider dentist shall be the same as the payment or reimbursement for a contracting provider dentist; provided, however, that the health insurance policy or the employee benefit plan shall not be required to make payment or reimbursement in an amount which is greater than the amount specified or which is greater than the fee charged by the providing dentist for the dental care services rendered.

HISTORY: SOURCES: Laws, 1985, ch. 369, § 3, eff from and after July 1, 1985.

83-51-11. Contracts between dentist and patient; authority of provider of health insurance policy or employee benefit plan 

   Notwithstanding any other provision of this chapter:

   (a) A dentist may contract directly with a patient for the furnishing of dental care services to such patient as may be otherwise authorized by law;

   (b) Any person providing a health insurance policy or employee benefit plan, or an employer, or an employee organization may:

      (i) Make available to its insureds, beneficiaries, participants, employees or members information relating to dental care services by distributing factually accurate information regarding dental care services, rates, fees, location and hours of service, provided such distribution is made upon the request of any dentist licensed by the state; or

      (ii) Establish an administrative mechanism which facilitates payment for dental care services by insureds, beneficiaries, participants, employees or members to the dentist of their choice; or

      (iii) Pay or reimburse, on a non-discriminatory basis, its insureds, beneficiaries, participants, employees or members for the cost of dental care services rendered by the dentist of their choice.

HISTORY: SOURCES: Laws, 1985, ch. 369, § 6, eff from and after July 1, 1985.

83-51-31. Prohibition against contract between certain health care entities and dentists from requiring that dentist provide services to subscribers at fee established by health care entity unless services are covered services under subscriber agreement 


   No contract between a health care entity that offers a dental plan or plans and a dentist for the provision of services to subscribers may require that a dentist provide services to his subscribers at a fee set by the health care entity unless the services are covered services under the applicable subscriber agreement. For the purposes of this section, "covered services" means services that are reimbursable under the applicable subscriber agreement, notwithstanding any deductibles, waiting periods or frequency limitations that may apply. For the purposes of this section, "dental plan" means any policy of insurance that is issued by a health care entity that provides for coverage of dental services not in connection with a medical plan.

HISTORY: SOURCES: Laws, 2010, ch. 497, § 1; Laws, 2012, ch. 318, § 1, eff from and after July 1, 2012.

AN ACT TO AMEND SECTION 83-51-1, MISSISSIPPI CODE OF 1972, TO DEFINE CERTAIN TERMS AS USED IN THE DENTAL CARE BENEFITS LAW TO CREATE A NEW SECTION TO REQUIRE DENTAL SERVICE CONTRACTORS TO ESTABLISH APPEAL PROCEDURES FOR CLAIM DENIALS BASED UPON LACK OF MEDICAL NECESSITY; TO PROHIBIT CLAIM DENIALS FOR PROCEDURES SPECIFICALLY INCLUDED IN A PRIOR AUTHORIZATION UNLESS CERTAIN CIRCUMSTANCES APPLY; TO PROVIDE A TIME LIMIT FOR PRIOR AUTHORIZATION APPROVALS; TO PROHIBIT THE RECOUPMENT OF A CLAIM IN CERTAIN CIRCUMSTANCES; AND FOR RELATED PURPOSES.

MISSISSIPPI LEGISLATURE REGULAR SESSION 2019

AN ACT TO AMEND SECTION 83-51-1, MISSISSIPPI CODE OF 1972,
TO 1.DEFINE CERTAIN TERMS AS USED IN THE DENTAL CARE BENEFITS
LAW ; TO 2 CREATE A NEW SECTION TO REQUIRE DENTAL SERVICE
CONTRACTORS TO 3 ESTABLISH APPEAL PROCEDURES FOR CLAIM DENIALS BASED UPON LACK OF 4 MEDICAL NECESSITY; TO PROHIBIT CLAIM DENIALS FOR PROCEDURES 5 SPECIFICALLY INCLUDED IN A PRIOR AUTHORIZATION UNLESS CERTAIN 6 CIRCUMSTANCES APPLY; TO PROVIDE A TIME LIMIT FOR PRIOR 7 AUTHORIZATION APPROVALS; TO PROHIBIT THE RECOUPMENT OF A CLAIM IN 8 CERTAIN CIRCUMSTANCES; AND FOR RELATED PURPOSES.