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Filing a Clean Claim Complaint with the Department of Insurance and Financial Services

A health care provider alleging that a clean claim has not been timely processed or paid may file a complaint with DIFS on form FIS 0284 and has a right to a determination of the matter by the Director or his or her designee. A health care provider or health plan may also seek court action.

A health care provider can file a clean claim complaint. Individuals or policyholders cannot file a clean claim complaint.

A health plan shall not terminate the affiliation status or the participation of a health care provider with a health maintenance organization provider panel or otherwise discriminate against a health care provider because the provider alleges that a health plan has violated Section 2006(7) to (14) of the Insurance Code.