58-12-20. Time limits for processing clean claims--Time limit for additional information required.
Each clean claim shall be paid to the person entitled thereto, denied, or settled within thirty calendar days after receipt by the carrier if submitted electronically and within forty-five calendar days after receipt by the carrier and if the claim is payable under the plan. If the resolution of an otherwise clean claim requires additional information, the carrier shall, within thirty calendar days after receipt of the claim, give the provider, policyholder, insured, or patient, as appropriate, a full explanation of what additional information is needed in order to determine eligibility or adjudicate the claim. The person receiving a request for additional information shall submit all additional information requested by the carrier within thirty calendar days after receipt of such request.
Source: SL 2001, ch 273, §2.
Structure South Dakota Codified Laws
Chapter 12 - Insurance Claims And Benefits
Section 58-12-1 - Forms for proof of loss--Furnishing by insurer on request.
Section 58-12-2 - Acts of insurer not constituting waiver of policy provision or defense.
Section 58-12-4 - Life and health insurance--Exemption of benefits and proceeds from execution.
Section 58-12-5 - "Annuity contract" defined.
Section 58-12-8 - Maximum amount of annuity exemption--Excess subject to levy.
Section 58-12-9 - Application of excess annuities to judgment--Factors considered.
Section 58-12-12 - Use of uniform health insurance claim forms.
Section 58-12-13 - Use of claim forms required by federal law excepted.
Section 58-12-14 - Promulgation of rules for uniform health insurance claim forms.
Section 58-12-15 - "Paintless dent repair" defined.
Section 58-12-18 - Compliance with § 58-12-16.
Section 58-12-19 - Clean claim defined.
Section 58-12-25 - Reimbursement to department for cost of services.
Section 58-12-26 - Insurer defined.
Section 58-12-27 - Department defined.
Section 58-12-28 - Provisions of chapter 1-27 not applicable to insurer records.
Section 58-12-31 - Definitions regarding standards for claims processing.
Section 58-12-32 - Application of standards for claims investigation and disposition.
Section 58-12-34 - Acts constituting unfair claims practices.
Section 58-12-35 - Notice of hearing.
Section 58-12-36 - Cease and desist order--Monetary penalty--Suspension or revocation of license.
Section 58-12-37 - Promulgation of rules regarding definitions and records.