Missouri Code of State Regulations
Title 20 - DEPARTMENT OF COMMERCE AND INSURANCE
Division 400 - Life, Annuities and Health
Chapter 14 - External Arbitration
Section 20 CSR 400-14.100 - External Arbitration
Current through Register Vol. 49, No. 6, March 15, 2024
PURPOSE: This rule outlines the procedures by which the department will ensure access to binding arbitration when there is a dispute related to a claim for unanticipated out-of-network care and outlines the criteria for approved arbitrators. This rule is promulgated pursuant to sections 374.045 and 376.690, RSMo.
(1) When a health carrier or a health care professional provides written notification to the director and the other party of its intent to initiate arbitration proceedings pursuant to section 376.690.2(5), RSMo, the health carrier or health care professional shall provide the following information to the director:
(2) Prior to commencing arbitration proceedings pursuant to section 376.690.2(5), RSMo, a health care professional and a health carrier must demonstrate they have completed the negotiation period described in section 376.690.2(1)-(3), RSMo.
(3) The director shall publish on the department's website (www.insurance.mo.gov) a list of entities providing arbitration services.
(4) In order to qualify as a provider of arbitration services as described in section 376.690, RSMo, an entity or arbitrator must-
(5) An arbitrator or entity seeking to be included on the list published by the department may submit such a request in writing to the director, outlining its qualifications. The director has sole discretion to determine whether or not to include an arbitrator or arbitration entity on the list published by the department, and may amend or revise the list from time-to-time as he or she deems necessary.