House Bill hb0293

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    Florida House of Representatives - 2002                 HB 293

        By Representative Benson






  1                      A bill to be entitled

  2         An act relating to health insurance; amending

  3         s. 408.7057, F.S.; redefining "managed care

  4         organization"; providing for filing certain

  5         claim disputes with a dispute-resolution

  6         organization under certain circumstances;

  7         amending s. 627.4235, F.S.; providing a

  8         definition; including prepaid health plans

  9         under coordination of benefits provisions;

10         providing for coordination of benefits under

11         multiple health insurance policies regardless

12         of time periods under certain circumstances;

13         amending s. 627.613, F.S.; revising time of

14         payment of claims provisions; requiring the

15         Department of Insurance to adopt rules

16         consistent with federal standards; providing

17         requirements and procedures for payment or

18         denial of claims; providing criteria and

19         limitations; amending s. 627.614, F.S.;

20         entitling insureds to prompt insurer payments

21         of claims for covered services; requiring

22         payment within specified periods; providing

23         payment procedures; providing penalties;

24         creating s. 627.6142, F.S.; providing a

25         definition; requiring health insurers to

26         provide lists of medical care and health care

27         services that require authorization;

28         prohibiting denial of certain claims; providing

29         procedural requirements for determination and

30         issuance of authorizations of services;

31         amending s. 627.6471, F.S.; revising

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  1         limitations on policies providing differing

  2         schedules of payments for preferred provider

  3         services and nonpreferred provider services;

  4         amending s. 627.662, F.S.; specifying

  5         application of certain additional provisions to

  6         group, blanket, and franchise health insurance;

  7         amending s. 641.185, F.S.; entitling health

  8         maintenance organization subscribers to prompt

  9         payment by the organization for covered

10         services by an out-of-network provider;

11         requiring payment within specified periods;

12         providing payment procedures; providing

13         penalties; amending s. 641.30, F.S.; conforming

14         a cross reference; amending s. 641.3155, F.S.;

15         providing a definition; requiring the

16         Department of Insurance to adopt rules

17         consistent with federal claim-filing standards;

18         providing requirements and procedures for

19         payment of claims; requiring payment within

20         specified periods; requiring the payment of

21         interest on overdue payments; requiring

22         coordination of benefits; providing remedies

23         for certain violations; providing for

24         attorney's fees and costs under certain

25         circumstances; amending s. 641.3156, F.S.;

26         providing a definition; requiring health

27         maintenance organizations to provide lists of

28         medical care and health care services that

29         require authorization; prohibiting denial of

30         certain claims; providing procedural

31         requirements for determination and issuance of

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  1         authorizations of services; amending s.

  2         627.651, F.S.; correcting a cross reference, to

  3         conform; repealing s. 627.647, F.S., relating

  4         to standard health claim forms; providing

  5         effective dates.

  6

  7  Be It Enacted by the Legislature of the State of Florida:

  8

  9         Section 1.  Paragraph (a) of subsection (1) and

10  paragraph (c) of subsection (2) of section 408.7057, Florida

11  Statutes, are amended to read:

12         408.7057  Statewide provider and managed care

13  organization claim dispute resolution program.--

14         (1)  As used in this section, the term:

15         (a)  "Managed care organization" means a health

16  maintenance organization or a prepaid health clinic certified

17  under chapter 641, a prepaid health plan authorized under s.

18  409.912, or an exclusive provider organization certified under

19  s. 627.6472, or a preferred provider organization.

20         (2)

21         (c)  Contracts entered into or renewed on or after

22  October 1, 2000, may require exhaustion of an internal

23  dispute-resolution process as a prerequisite to the submission

24  of a claim by a provider or health maintenance organization to

25  the resolution organization when the dispute-resolution

26  program becomes effective; provided that, if the internal

27  dispute-resolution process is not completed within 60 calendar

28  days after the filing of the claim dispute with the managed

29  care maintenance organization, the provider may file a claim

30  dispute with a dispute-resolution organization.

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  1         Section 2.  Section 627.4235, Florida Statutes, is

  2  amended to read:

  3         627.4235  Coordination of benefits.--

  4         (1)  For purposes of this section, "coordination of

  5  benefits" or "coordinating benefits" means establishing an

  6  order, or operating pursuant to an established order, under

  7  which primary plans pay claims and secondary plans are

  8  permitted to reduce benefits paid so that the combined

  9  benefits paid under all plans do not exceed covered charges.

10         (2)(1)  A group hospital, medical, or surgical expense

11  policy, group health care services plan, prepaid health plan

12  licensed pursuant to chapter 641, or group-type self-insurance

13  plan that provides protection or insurance against hospital,

14  medical, or surgical expenses delivered or issued for delivery

15  in this state must contain a provision for coordinating its

16  benefits with any similar benefits provided by any other group

17  hospital, medical, or surgical expense policy, any group

18  health care services plan, prepaid health plan licensed

19  pursuant to chapter 641, or any group-type self-insurance plan

20  that provides protection or insurance against hospital,

21  medical, or surgical expenses for the same loss.

22         (3)(2)  A hospital, medical, or surgical expense

23  policy, health care services plan, prepaid health plan

24  licensed pursuant to chapter 641, or self-insurance plan that

25  provides protection or insurance against hospital, medical, or

26  surgical expenses issued in this state or issued for delivery

27  in this state shall may contain a provision whereby the

28  insurer may reduce or refuse to pay benefits otherwise payable

29  thereunder solely on account of the existence of similar

30  benefits provided under insurance policies issued by the same

31  or another insurer, health care services plan, prepaid health

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  1  plan licensed pursuant to chapter 641, or self-insurance plan

  2  which provides protection or insurance against hospital,

  3  medical, or surgical expenses only if, as a condition of

  4  coordinating benefits with another insurer, the insurers

  5  together pay 100 percent of the total covered charges for

  6  reasonable expenses actually incurred of the type of expense

  7  within the benefits described in the policies and presented to

  8  the insurer for payment.

  9         (4)(3)  The standards provided in subsection (3) (2)

10  apply to coordination of benefits payable under Medicare,

11  Title XVIII of the Social Security Act.

12         (5)(4)  If a claim is submitted in accordance with any

13  group hospital, medical, or surgical expense policy, or in

14  accordance with any group health care service plan or

15  group-type self-insurance plan, that provides protection,

16  insurance, or indemnity against hospital, medical, or surgical

17  expenses, and the policy or any other document that provides

18  coverage includes a coordination-of-benefits provision and the

19  claim involves another policy or plan which has a

20  coordination-of-benefits provision, the following rules

21  determine the order in which benefits under the respective

22  health policies or plans will be determined:

23         (a)1.  The benefits of a policy or plan which covers

24  the person as an employee, member, or subscriber, other than

25  as a dependent, are determined before those of the policy or

26  plan which covers the person as a dependent.

27         2.  However, if the person is also a Medicare

28  beneficiary, and if the rule established under the Social

29  Security Act of 1965, as amended, makes Medicare secondary to

30  the plan covering the person as a dependent of an active

31  employee, the order of benefit determination is:

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  1         a.  First, benefits of a plan covering a person as an

  2  employee, member, or subscriber.

  3         b.  Second, benefits of a plan of an active worker

  4  covering a person as a dependent.

  5         c.  Third, Medicare benefits.

  6         (b)  Except as stated in paragraph (c), if two or more

  7  policies or plans cover the same child as a dependent of

  8  different parents:

  9         1.  The benefits of the policy or plan of the parent

10  whose birthday, excluding year of birth, falls earlier in a

11  year are determined before the benefits of the policy or plan

12  of the parent whose birthday, excluding year of birth, falls

13  later in that year; but

14         2.  If both parents have the same birthday, the

15  benefits of the policy or plan which covered the parent for a

16  longer period of time are determined before those of the

17  policy or plan which covered the parent for a shorter period

18  of time.

19

20  However, if a policy or plan subject to the rule based on the

21  birthdays of the parents coordinates with an out-of-state

22  policy or plan which contains provisions under which the

23  benefits of a policy or plan which covers a person as a

24  dependent of a male are determined before those of a policy or

25  plan which covers the person as a dependent of a female and

26  if, as a result, the policies or plans do not agree on the

27  order of benefits, the provisions of the other policy or plan

28  determine the order of benefits.

29         (c)  If two or more policies or plans cover a dependent

30  child of divorced or separated parents, benefits for the child

31  are determined in this order:

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  1         1.  First, the policy or plan of the parent with

  2  custody of the child.

  3         2.  Second, the policy or plan of the spouse of the

  4  parent with custody of the child.

  5         3.  Third, the policy or plan of the parent not having

  6  custody of the child.

  7

  8  However, if the specific terms of a court decree state that

  9  one of the parents is responsible for the health care expenses

10  of the child and if the entity obliged to pay or provide the

11  benefits of the policy or plan of that parent has actual

12  knowledge of those terms, the benefits of that policy or plan

13  are determined first, except with respect to any claim

14  determination period or plan or policy year during which any

15  benefits are actually paid or provided before the entity has

16  the actual knowledge.

17         (d)  The benefits of a policy or plan which covers a

18  person as an employee who is neither laid off nor retired, or

19  as that employee's dependent, are determined before those of a

20  policy or plan which covers the person as a laid-off or

21  retired employee or as the employee's dependent.  If the other

22  policy or plan is not subject to this rule, and if, as a

23  result, the policies or plans do not agree on the order of

24  benefits, this paragraph does not apply.

25         (e)  If none of the rules in paragraph (a), paragraph

26  (b), paragraph (c), or paragraph (d) determine the order of

27  benefits, the benefits of the policy or plan which covered an

28  employee, member, or subscriber for a longer period of time

29  are determined before those of the policy or plan which

30  covered the person for the shorter period of time.

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  1         (6)(5)  Coordination of benefits is not permitted

  2  against an indemnity-type policy, an excess insurance policy

  3  as defined in s. 627.635, a policy with coverage limited to

  4  specified illnesses or accidents, or a Medicare supplement

  5  policy.

  6         (7)(6)  If an individual is covered under a COBRA

  7  continuation plan as a result of the purchase of coverage as

  8  provided under the Consolidation Omnibus Budget Reconciliation

  9  Act of 1987 (Pub. L. No. 99-272), and also under another group

10  plan, the following order of benefits applies:

11         (a)  First, the plan covering the person as an

12  employee, or as the employee's dependent.

13         (b)  Second, the coverage purchased under the plan

14  covering the person as a former employee, or as the former

15  employee's dependent provided according to the provisions of

16  COBRA.

17         (8)  If the insured fails to furnish the provider with

18  the correct name and address of the insured's primary insurer,

19  and the claim is submitted to a secondary insurer or prepaid

20  health plan licensed pursuant to chapter 641 and the claim is

21  subsequently rejected, the provider has 60 calendar days from

22  the date the provider obtains the correct billing information

23  to submit a claim to either the primary or secondary insurer,

24  regardless of any time periods for filing of claims

25  established by any applicable contract.

26         Section 3.  Effective October 16, 2002, section

27  627.613, Florida Statutes, is amended to read:

28         (Substantial rewording of section.

29         See s. 627.613, F.S., for present text.)

30         627.613  Time of payment of claims.--

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  1         (1)(a)  As used in this section, for a noninstitutional

  2  provider, "claim" means a paper or electronic billing

  3  instrument that consists of the HCFA 1500 data set that has

  4  all mandatory entries completed for a physician licensed under

  5  chapter 458 or chapter 459 or other appropriate form for any

  6  other noninstitutional provider, or its successor. For

  7  institutional providers, "claim" means a paper or electronic

  8  billing instrument that consists of the UB-92 data set or its

  9  successor that has all mandatory entries completed.

10         (b)  The department shall adopt rules to establish

11  claim forms consistent with federal claim-filing standards for

12  health insurers required by the Secretary of the United States

13  Department of Health and Human Services. The department shall

14  adopt rules to require code sets consistent with code sets

15  adopted by the Secretary of the United States Department of

16  Health and Human Services. The code sets shall apply to

17  electronic claims. A code set, as defined by the secretary,

18  includes both the codes and the descriptors of the codes and

19  shall include, but not be limited to:

20         1.  Medical data code sets, including the International

21  Classification of Diseases, the HCFA Common Procedure Coding

22  System and current procedure terminology, and the HCFA Common

23  Procedure Coding System for supplies and other health care

24  items.

25         2.  Health care claims or equivalent encounter

26  information for professional health care claims and

27  institutional health care claims.

28         3.  Eligibility for a health plan standard.

29         4.  Referral certification and authorization standard.

30         5.  Health care claim status standard.

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  1         6.  Enrollment and disenrollment in a health plan

  2  standard.

  3         7.  Health care payment and remittance advice standard.

  4         8.  Coordination of benefits standard.

  5         9.  Revenue codes used by Medicare for processing

  6  claims.

  7         10.  National Correct Coding Initiative edits used by

  8  Medicare.

  9         (c)  All providers and payors shall use only the

10  standard code sets defined for their area of operation by the

11  Secretary of the United States Department of Health and Human

12  Services for the filing and adjudication of electronic claims.

13  The version of the code set shall be the version that is valid

14  at the time the health care is furnished, defined as the date

15  of discharge for inpatient services and date of service for

16  health care provided in an outpatient or ambulatory setting.

17         (2)(a)  A health insurer shall pay any claim or any

18  portion of a claim made by a contract provider for services or

19  goods provided under a contract with the health insurer or a

20  claim made by a noncontracted provider, which the insurer does

21  not contest or deny, within 15 calendar days after receipt of

22  the claim by the health insurer that is electronically

23  submitted by the provider, or within 35 calendar days after

24  receipt of the claim by the health insurer that is submitted

25  by the provider using either hand delivery, the United States

26  mail, or a reputable overnight delivery service. The

27  investigation and determination of eligibility for payment,

28  including any coordination of any other payments, does not

29  extend the time periods specified in this paragraph.

30         (b)  A health insurer that denies or contests a

31  provider's claim or any portion of a claim shall notify the

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  1  provider within 35 calendar days after the health insurer

  2  receives the claim, if submitted by hand delivery, United

  3  States mail, or overnight delivery service, or within 15

  4  calendar days after the health insurer receives the claim if

  5  submitted by electronic means, that the claim is contested or

  6  denied. The notice that the claim is contested or denied shall

  7  identify the contested portion of the claim and the specific

  8  reason for contesting or denying the claim and, if contested,

  9  shall give the provider a written itemization of any

10  additional information or additional documents needed to

11  process the claim or any portion of the claim that is not

12  being paid. The health insurer shall pay or deny the claim or

13  portion of the claim within 35 calendar days after receipt of

14  the information. A health insurer may not make more than one

15  request under this paragraph in connection with a claim,

16  unless the provider fails to submit all of the requested

17  information to process the claim, in which case the health

18  insurer may provide the health care provider with one

19  additional opportunity to submit the additional information

20  needed to process the claim.

21         (c)  If a health insurer requests additional

22  information or additional documents from a person other than

23  the provider who submitted the claim, the health insurer shall

24  provide a copy of the request to the provider who submitted

25  the claim.  The health insurer may not withhold payment

26  pending receipt of information or documents requested under

27  this paragraph. A health insurer may not deny or withhold

28  payment on a claim because the insured has not paid a required

29  deductible or copayment.

30         (3)  Payment of a claim is considered made on the date

31  the payment is received, electronically transferred, or

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  1  otherwise delivered. An insurer that does not pay a claim when

  2  payment is due as provided in subsection (4) shall pay the

  3  provider submitting the claim the provider's billed charges

  4  submitted on the claim.

  5         (4)  A health insurer shall pay or deny any claim no

  6  later than 50 calendar days after receiving the claim if the

  7  claim is submitted electronically, or no later than 70

  8  calendar days if the claim is submitted by hand delivery,

  9  United States mail, or a reputable overnight delivery service.

10  Failure to pay or deny a claim within such time periods

11  creates an uncontestable obligation of the health insurer to

12  pay the claim to the provider. The running of the time

13  specified in this subsection shall be tolled by the number of

14  days taken by the provider who submitted the claim to submit

15  the additional information requested by the insurer pursuant

16  to paragraph (2)(b).

17         (5)  If, as a result of retroactive review of coverage

18  decisions or payment levels, a health insurer determines that

19  the insurer has made an overpayment to a provider for services

20  rendered to an insured, the insurer may not reduce payment to

21  that provider for other services. The look-back or audit

22  review period may not exceed 1 year from the date of discharge

23  or 1 year from the date the health service was provided.

24         (6)  A provider claim for payment shall be considered

25  received by the health insurer, if the claim has been

26  electronically transmitted to the health insurer, when receipt

27  is verified electronically; if the claim is mailed by United

28  States mail to the address disclosed by the insurer, on the

29  date indicated on the return receipt; or, if the claim is hand

30  delivered, on the date the delivery receipt is signed by the

31  health insurer. A health insurer shall not require a provider

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  1  to resubmit a claim for payment if the claim has been received

  2  by the insurer. A provider shall wait 35 calendar days

  3  following receipt of a claim before submitting a duplicate

  4  claim.

  5         (7)  A health insurer shall provide a provider or the

  6  provider's designee, who bills electronically, electronic

  7  acknowledgment of the receipt of a claim within 24 hours after

  8  receipt.

  9         (8)  A health insurer may not retroactively deny a

10  claim because of subscriber ineligibility.

11         (9)(a)  Without regard to any other remedy or relief to

12  which a provider is entitled, any provider aggrieved by a

13  violation of this section by a health insurer may bring an

14  action to enjoin a person who has violated, or is violating,

15  this section. In any such action, the provider who has

16  suffered a loss as a result of the violation may recover any

17  amounts due the provider by the health insurer, including

18  accrued interest, plus attorney's fees and costs as provided

19  in paragraph (b).

20         (b)  In any action arising out of a violation of this

21  section by a health insurer where the health insurer is found

22  to have violated this section, the provider, after judgment in

23  the trial court and after exhausting all appeals, if any,

24  shall receive his or her reasonable attorney's fees and costs

25  from the health insurer.

26         (10)  The provisions of this section apply to contracts

27  entered into pursuant to ss. 627.6471 and 627.6472.

28         (11)  The provisions of this section may not be waived,

29  voided, or nullified by contract.

30         Section 4.  Subsection (3) is added to section 627.614,

31  Florida Statutes, to read:

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  1         627.614  Payment of claims.--

  2         (3)  An insured is entitled to prompt payment from an

  3  insurer for claims submitted for a covered service.  If the

  4  claim is submitted electronically by the insured or on the

  5  insured's behalf, the claim shall be paid to the insured

  6  within 15 days or the insurer shall advise the insured of what

  7  additional information is required to adjudicate the claim.

  8  After receipt of the additional information, the insurer shall

  9  pay the claim within 10 days. If the claim is submitted by

10  electronic facsimile, United States mail, or overnight

11  delivery service, the insurer shall pay the claim within 30

12  days or the insurer shall advise the insured of what

13  additional information is required to adjudicate the claim.

14  After receipt of the additional information, the insurer shall

15  pay the claim within 10 days.  If the insurer fails to pay a

16  claim submitted by an insured within the time periods

17  specified in this subsection, the insurer shall pay the

18  insured twice the amount of the claim. Failure to pay claims

19  and penalties, if applicable, within the time periods

20  specified in this subsection is a violation of the insurance

21  code and each occurrence shall be considered a separate

22  violation.

23         Section 5.  Section 627.6142, Florida Statutes, is

24  created to read:

25         627.6142  Treatment authorization; payment of claims.--

26         (1)  For purposes of this section, "authorization"

27  includes any requirement of a provider to notify an insurer in

28  advance of providing a covered service, regardless of whether

29  the actual terminology used by the insurer includes, but is

30  not limited to, preauthorization, precertification,

31  notification, or any other similar terminology.

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  1         (2)  A health insurer that requires authorization for

  2  medical care or health care services shall provide to each

  3  provider with whom the health insurer has contracted pursuant

  4  to s. 627.6471 or s. 627.6472 a list of the medical care and

  5  health care services that require authorization and the

  6  authorization procedures used by the health insurer at the

  7  time a contract becomes effective. A health insurer that

  8  requires authorization for medical care or health care

  9  services shall provide to all other providers, not later than

10  10 working days after a request is made, a list of the medical

11  care and health care services that require authorization and

12  the authorization procedures established by the insurer. The

13  medical care or health care services that require

14  authorization and the authorization procedures used by the

15  insurer shall not be modified unless written notice is

16  provided at least 30 days in advance of any changes to all

17  affected insureds as well as to all contracted providers and

18  all other providers that had previously requested in writing a

19  list of medical care or health care services that require

20  authorization.

21         (3)  Any claim for treatment that does not require

22  authorization that is ordered by a physician and entered on

23  the medical record may not be denied.

24         (4)(a)  Any claim for treatment may not be denied if a

25  provider follows the health insurer's published authorization

26  procedures and receives authorization, unless the provider

27  submits information to the health insurer with the willful

28  intention to misinform the health insurer.

29         (b)  Upon receipt of a request from a provider for

30  authorization, the health insurer shall issue a determination

31  indicating whether the service or services are authorized. The

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  1  determination shall be transmitted to the provider making the

  2  request in writing no later than 8 hours after the request is

  3  made by the provider. If the health insurer denies the request

  4  for authorization, the health insurer shall notify the insured

  5  at the same time the insurer notifies the provider requesting

  6  the authorization. A health insurer that fails to respond to a

  7  request for an authorization pursuant to this paragraph within

  8  8 hours is considered to have authorized the requested medical

  9  care or health care service and payment shall not be denied.

10         (5)  If the proposed medical care or health care

11  service or services involve an inpatient admission and the

12  health insurer requires an authorization as a condition of

13  payment, the health insurer shall review and issue a written

14  or electronic authorization for the total estimated length of

15  stay for the admission, based on the recommendation of the

16  patient's physician. If the proposed medical care or health

17  care service or services are to be provided to an insured who

18  is an inpatient in a health care facility and authorization is

19  required, the health insurer shall issue a written

20  determination indicating whether the proposed services are

21  authorized or denied no later than 1 hour after the request is

22  made by the provider. A health insurer who fails to respond to

23  such request within 1 hour is considered to have authorized

24  the requested medical service or health care service and

25  payment shall not be denied.

26         (6)  Emergency services and care are subject to the

27  provisions of s. 641.513 and are not subject to the provisions

28  of this section, including any inpatient admission required in

29  order to stabilize the patient pursuant to federal and state

30  law.

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  1         (7)  The provisions of this section may not be waived,

  2  voided, or nullified by contract.

  3         (8)  The provisions of this section apply to contracts

  4  entered into pursuant to ss. 627.6471 and 627.6472.

  5         Section 6.  Paragraph (h) of subsection (4) of section

  6  627.6471, Florida Statutes, is amended to read:

  7         627.6471  Contracts for reduced rates of payment;

  8  limitations; coinsurance and deductibles.--

  9         (4)  Any policy that provides schedules of payments for

10  services provided by preferred providers that differ from the

11  schedules of payments for services provided by nonpreferred

12  providers is subject to the following limitations:

13         (h)  Each preferred provider shall be given a list of

14  all payors with whom the insurer has entered into agreements

15  to use the services of the preferred provider and no

16  additional payors shall be added to the agreement unless

17  approved by the preferred provider.  Neither the insurer nor

18  the insurer's claims administrator shall disclose contract

19  rate information without the written approval of the preferred

20  provider. If any service or treatment is not within the scope

21  of services provided by the network of preferred providers,

22  but is within the scope of services or treatment covered by

23  the policy, the service or treatment shall be reimbursed at a

24  rate not less than 10 percentage points lower than the

25  percentage rate paid to preferred providers.  The

26  reimbursement rate must be applied to the usual and customary

27  charges in the area.

28         Section 7.  Section 627.662, Florida Statutes, is

29  amended to read:

30

31

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  1         627.662  Other provisions applicable.--The following

  2  provisions apply to group health insurance, blanket health

  3  insurance, and franchise health insurance:

  4         (1)  Section 627.569, relating to use of dividends,

  5  refunds, rate reductions, commissions, and service fees.

  6         (2)  Section 627.602(1)(f) and (2), relating to

  7  identification numbers and statement of deductible provisions.

  8         (3)  Section 627.635, relating to excess insurance.

  9         (4)  Section 627.638, relating to direct payment for

10  hospital or medical services.

11         (5)  Section 627.640, relating to filing and

12  classification of rates.

13         (6)  Section 627.4235, relating to coordination of

14  benefits.

15         (7)  Section 627.614, relating to payment of claims.

16         (8)  Section 627.6142, relating to treatment

17  authorizations.

18         (9)(6)  Section 627.645(1), relating to denial of

19  claims.

20         (10)(7)  Section 627.613, relating to time of payment

21  of claims.

22         (11)(8)  Section 627.6471, relating to preferred

23  provider organizations.

24         (12)(9)  Section 627.6472, relating to exclusive

25  provider organizations.

26         (13)(10)  Section 627.6473, relating to combined

27  preferred provider and exclusive provider policies.

28         (14)(11)  Section 627.6474, relating to provider

29  contracts.

30         Section 8.  Paragraph (m) is added to subsection (1) of

31  section 641.185, Florida Statutes, to read:

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  1         641.185  Health maintenance organization subscriber

  2  protections.--

  3         (1)  With respect to the provisions of this part and

  4  part III, the principles expressed in the following statements

  5  shall serve as standards to be followed by the Department of

  6  Insurance and the Agency for Health Care Administration in

  7  exercising their powers and duties, in exercising

  8  administrative discretion, in administrative interpretations

  9  of the law, in enforcing its provisions, and in adopting

10  rules:

11         (m)  A health maintenance organization subscriber is

12  entitled to prompt payment from the organization whenever a

13  subscriber pays an out-of-network provider for a covered

14  service and then submits a claim to the organization. If the

15  claim is submitted electronically by the subscriber or on the

16  subscriber's behalf by the out-of-network provider, the claim

17  shall be paid to the subscriber within 15 days or the

18  organization shall advise the subscriber of what additional

19  information is required to adjudicate the claim. After receipt

20  of the additional information, the organization shall pay the

21  claim within 10 days. If the claim is submitted by United

22  States mail or overnight delivery service, the organization

23  shall pay the claim within 30 days or the organization shall

24  advise the subscriber of what additional information is

25  required to adjudicate the claim. After receipt of the

26  additional information, the organization shall pay the claim

27  within 10 days. If the organization fails to pay claims

28  submitted by subscribers within the time periods specified in

29  this paragraph, the organization shall pay the subscriber

30  twice the amount of the claim. Failure to pay claims and

31  penalties, if applicable, within the time periods specified in

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  1  this paragraph, is a violation of the insurance code and each

  2  occurrence shall be considered a separate violation.

  3         Section 9.  Effective October 16, 2002, subsection (1)

  4  of section 641.30, Florida Statutes, is amended to read:

  5         641.30  Construction and relationship to other laws.--

  6         (1)  Every health maintenance organization shall accept

  7  the standard health claim form prescribed pursuant to s.

  8  641.3155 627.647.

  9         Section 10.  Effective October 16, 2002, section

10  641.3155, Florida Statutes, is amended to read:

11         641.3155  Payment of claims.--

12         (1)(a)  As used in this section, the term "clean claim"

13  for a noninstitutional provider means a paper or electronic

14  billing instrument that consists of the HCFA 1500 data set

15  that has all mandatory entries for a physician licensed under

16  chapter 458 or chapter 459 or other appropriate form for any

17  other noninstitutional provider, or its successor. For

18  institutional providers, "claim" means a paper or electronic

19  billing instrument that consists of the UB-92 data set or its

20  successor that has all mandatory entries. claim submitted on a

21  HCFA 1500 form which has no defect or impropriety, including

22  lack of required substantiating documentation for

23  noncontracted providers and suppliers, or particular

24  circumstances requiring special treatment which prevent timely

25  payment from being made on the claim. A claim may not be

26  considered not clean solely because a health maintenance

27  organization refers the claim to a medical specialist within

28  the health maintenance organization for examination. If

29  additional substantiating documentation, such as the medical

30  record or encounter data, is required from a source outside

31  the health maintenance organization, the claim is considered

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  1  not clean. This definition of "clean claim" is repealed on the

  2  effective date of rules adopted by the department which define

  3  the term "clean claim."

  4         (b)  Absent a written definition that is agreed upon

  5  through contract, the term "clean claim" for an institutional

  6  claim is a properly and accurately completed paper or

  7  electronic billing instrument that consists of the UB-92 data

  8  set or its successor with entries stated as mandatory by the

  9  National Uniform Billing Committee.

10         (b)(c)  The department shall adopt rules to establish

11  claim forms consistent with federal claim-filing standards for

12  health maintenance organizations required by the Secretary of

13  the United States Department of Health and Human Services

14  federal Health Care Financing Administration. The department

15  shall may adopt rules to require code sets consistent with

16  code sets adopted by the Secretary of the United States

17  Department of Health and Human Services. The code sets shall

18  apply to electronic claims. A code set, as defined by the

19  secretary, shall include both the codes and the descriptors of

20  the codes and shall also include, but not be limited to:

21         1.  Medical data code sets, including the International

22  Classification of Diseases, the HCFA Common Procedure Coding

23  System and current procedure terminology, and the HCFA Common

24  Procedure Coding System for supplies or other items used in

25  health care services.

26         2.  Health care claims or equivalent encounter

27  information for professional and institutional health care

28  claims.

29         3.  Eligibility for a health plan standard.

30         4.  Referral certification and authorization standard.

31         5.  Health care claim status standard.

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  1         6.  Health care payment and remittance advice standard.

  2         7.  Enrollment and disenrollment in a health plan

  3  standard.

  4         8.  Coordination of benefits standard.

  5         9.  Revenue codes used by Medicare for processing

  6  claims.

  7         10.  National Correct Coding Initiative edits used by

  8  Medicare relating to coding standards consistent with Medicare

  9  coding standards adopted by the federal Health Care Financing

10  Administration.

11         (c)  All providers and payors shall use the standard

12  code sets defined for their area of operation by the Secretary

13  of the United States Department of Health and Human Services

14  for the filing and adjudication of electronic claims. The

15  version of the code set shall be the version that is valid at

16  the time the health care is furnished, defined as the date of

17  discharge for inpatient services and date of service for

18  health care provided in an outpatient or ambulatory setting.

19         (2)(a)  A health maintenance organization shall pay any

20  clean claim or any portion of a clean claim made by a contract

21  provider for services or goods provided under a contract with

22  the health maintenance organization or a clean claim made by a

23  noncontract provider which the organization does not contest

24  or deny, within 15 35 days after receipt of the claim by the

25  health maintenance organization which is mailed or

26  electronically submitted transferred by the provider, or

27  within 35 calendar days after receipt of the claim by the

28  health maintenance organization that is submitted by the

29  provider using either hand delivery, the United States mail,

30  or a reputable overnight delivery service. The investigation

31  and determination of eligibility for payment, including any

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  1  coordination of any other payments, does not extend the time

  2  periods contained in this paragraph.

  3         (b)  A health maintenance organization that denies or

  4  contests a provider's claim or any portion of a claim shall

  5  notify the provider, in writing, within 35 calendar days after

  6  the health maintenance organization receives the claim, if

  7  submitted by hand delivery, United States mail, or overnight

  8  delivery service, or within 15 calendar days after the health

  9  maintenance organization receives the claim if submitted by

10  electronic means, that the claim is contested or denied. The

11  notice that the claim is denied or contested must identify the

12  contested portion of the claim and the specific reason for

13  contesting or denying the claim, and, if contested, must give

14  the provider a written itemization of any include a request

15  for additional information or additional documents needed to

16  process the claim or any portion of the claim that is not

17  being paid. If the provider submits additional information,

18  the provider must, within 35 days after receipt of the

19  request, mail or electronically transfer the information to

20  the health maintenance organization. The health maintenance

21  organization shall pay or deny the claim or portion of the

22  claim within 35 calendar 45 days after receipt of the

23  information from the provider. A health maintenance

24  organization may not make more than one request under this

25  paragraph in connection with a claim, unless the provider

26  fails to submit all of the requested information to process

27  the claim, in which case the health maintenance organization

28  may provide the health care provider with one additional

29  opportunity to submit the additional information needed to

30  process the claim.

31

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  1         (c)  If a health maintenance organization requests

  2  additional information or additional documents from a person

  3  other than the provider who submitted the claim, the health

  4  maintenance organization shall provide a copy of the request

  5  to the provider who submitted the claim.  The health

  6  maintenance organization shall not withhold payment pending

  7  receipt of information or documents requested under this

  8  paragraph.  If, upon receiving information or documents

  9  requested under this paragraph, the health maintenance

10  organization determines the existence of an error in payment

11  of the claim, the health maintenance organization may recover

12  the payment under subsection (5).

13         (d)  A health maintenance organization shall not deny

14  or withhold payment on a claim because the insured has not

15  paid a requested deductible or copayment.

16         (3)  Payment of a claim is considered made on the date

17  the payment was received or electronically transferred or

18  otherwise delivered. An insurer that does not pay a claim when

19  payment is due as provided in subsection (4) shall pay the

20  provider submitting the claim the full amount of the

21  provider's billed charges submitted on the claim or twice the

22  provider's contracted rate, whichever is less. An overdue

23  payment of a claim bears simple interest at the rate of 10

24  percent per year. Interest on an overdue payment for a clean

25  claim or for any uncontested portion of a clean claim begins

26  to accrue on the 36th day after the claim has been received.

27  The interest is payable with the payment of the claim.

28         (4)  A health maintenance organization shall pay or

29  deny any claim no later than 50 calendar 120 days after

30  receiving the claim if the claim is submitted electronically

31  or no later than 70 calendar days if the claim is submitted by

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  1  hand delivery, United States mail, or a reputable overnight

  2  delivery service. Failure to pay or deny a claim within such

  3  time periods do so creates an uncontestable obligation for the

  4  health maintenance organization to pay the claim to the

  5  provider. The running of the time specified in this subsection

  6  shall be tolled by the number of days taken by the provider

  7  who submitted the claim to submit the additional information

  8  requested by the health maintenance organization pursuant to

  9  paragraph (2)(b).

10         (5)(a)  If, as a result of retroactive review of

11  coverage decisions or payment levels, a health maintenance

12  organization determines that it has made an overpayment to a

13  provider for services rendered to a subscriber, the

14  organization must make a claim for such overpayment. The

15  organization may not reduce payment to that provider for other

16  services unless the provider agrees to the reduction in

17  writing after receipt of the claim for overpayment from the

18  health maintenance organization or fails to respond to the

19  organization's claim as required in this subsection.

20         (b)  A provider shall pay a claim for an overpayment

21  made by a health maintenance organization which the provider

22  does not contest or deny within 15 calendar 35 days after

23  receipt of the claim that is mailed or electronically

24  transferred to the provider, or within 35 calendar days after

25  receipt of the claim that is submitted to the provider using

26  either United States mail or a reputable overnight delivery

27  service.

28         (c)  A provider that denies or contests an

29  organization's claim for overpayment or any portion of a claim

30  shall notify the organization, in writing, within 35 calendar

31  days after the provider receives the claim if the claim is

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  1  submitted by United States mail or overnight delivery service,

  2  or within 15 calendar days after the provider receives the

  3  claim if the claim is electronically transferred to the

  4  provider, that the claim for overpayment is contested or

  5  denied. The notice that the claim for overpayment is denied or

  6  contested must identify the contested portion of the claim and

  7  the specific reason for contesting or denying the claim, and,

  8  if contested, must include a request for additional

  9  information. If the organization submits additional

10  information, the organization must, within 21 calendar 35 days

11  after receipt of the request, mail or electronically transfer

12  the information to the provider. The provider shall pay or

13  deny the claim for overpayment within 30 calendar 45 days

14  after receipt of the information.

15         (d)  Payment of a claim for overpayment is considered

16  made on the date payment was received or electronically

17  transferred or otherwise delivered to the organization, or the

18  date that the provider receives a payment from the

19  organization that reduces or deducts the overpayment. An

20  overdue payment of a claim bears simple interest at the rate

21  of 18 10 percent a year. Interest on an overdue payment of a

22  claim for overpayment or for any uncontested portion of a

23  claim for overpayment begins to accrue on the 36th day after

24  the claim for overpayment has been received.

25         (e)  A provider shall pay or deny any claim for

26  overpayment no later than 71 calendar 120 days after receiving

27  the claim if submitted electronically or no later than 91

28  calendar days if the claim for overpayment is submitted by

29  United States mail or overnight delivery service. Failure to

30  do so creates an uncontestable obligation for the provider to

31  pay the claim to the organization.

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  1         (6)  Any retroactive reductions of payments or demands

  2  for refund of previous overpayments which are due to

  3  retroactive review-of-coverage decisions or payment levels

  4  must be reconciled to specific claims unless the parties agree

  5  to other reconciliation methods and terms. Any retroactive

  6  demands by providers for payment due to underpayments or

  7  nonpayments for covered services must be reconciled to

  8  specific claims unless the parties agree to other

  9  reconciliation methods and terms. The look-back or audit

10  review period shall not exceed 1 year may be specified by the

11  terms of the contract.

12         (7)(a)  A provider claim for payment shall be

13  considered received by the health maintenance organization

14  when receipt is verified electronically, if the claim has been

15  electronically transmitted to the health maintenance

16  organization, on the date indicated on the return receipt when

17  receipt is verified electronically or, if the claim is mailed

18  by United States mail to the address disclosed by the

19  organization, or on the date the delivery receipt is signed by

20  the health maintenance organization if the claim is hand

21  delivered on the date indicated on the return receipt. A

22  health maintenance organization shall not require a provider

23  to resubmit a claim for payment if the claim has been received

24  by the organization. A provider must wait 45 calendar days

25  following receipt of a claim before submitting a duplicate

26  claim.

27         (b)  A health maintenance organization claim for

28  overpayment shall be considered received by a provider, if the

29  claim has been electronically transmitted to the provider,

30  when receipt is verified electronically or, if the claim is

31  mailed to the address disclosed by the provider, on the date

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  1  indicated on the return receipt. A provider shall not require

  2  a health maintenance organization to resubmit a claim for

  3  payment if the claim for overpayment has been received by the

  4  provider. An organization must wait 45 calendar days following

  5  the provider's receipt of a claim for overpayment before

  6  submitting a duplicate claim.

  7         (c)  This section does not preclude the health

  8  maintenance organization and provider from agreeing to other

  9  methods of transmission and receipt of claims.

10         (8)  A health maintenance organization shall provide a

11  provider, or the provider's designee who bills electronically,

12  electronic acknowledgment of the receipt of a claim within 24

13  hours after receipt. A provider, or the provider's designee,

14  who bills electronically is entitled to electronic

15  acknowledgment of the receipt of a claim within 72 hours.

16         (9)  A health maintenance organization may not

17  retroactively deny a claim because of subscriber ineligibility

18  more than 1 year after the date of payment of the clean claim.

19         (10)  A health maintenance organization shall pay a

20  contracted primary care or admitting physician, pursuant to

21  such physician's contract, for providing inpatient services in

22  a contracted hospital to a subscriber, if such services are

23  determined by the organization to be medically necessary and

24  covered services under the organization's contract with the

25  contract holder.

26         (11)(a)  Each policy issued by a health maintenance

27  organization shall contain a provision for coordinating

28  benefits under the policy with any similar benefits provided

29  by any other health maintenance organization, group hospital,

30  medical, or surgical expense policy; any group health care

31  services plan; any auto medical policy; any governmental

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  1  medical expense policy; or any group-type self-insurance plan

  2  that provides protection or insurance against hospital,

  3  medical, or surgical expenses for the same loss.

  4         (b)  A policy issued by a health maintenance

  5  organization shall contain a provision whereby the health

  6  maintenance organization may reduce or refuse to pay benefits

  7  otherwise payable under the policy solely due to the existence

  8  of similar benefits provided under insurance policies issued

  9  by the same or another health maintenance organization,

10  insurer, health care services plan, or self-insurance plan if

11  the similar benefits provide protection or insurance against

12  hospital, medical, or surgical expenses only if, as a

13  condition of coordinating benefits with another insurer, 100

14  percent of the total covered changes described in the policies

15  and presented for payment are paid.

16         (c)  If a subscriber fails to furnish the provider with

17  the correct name and address of the subscriber's primary

18  prepaid health plan, group hospital, medical, or surgical

19  expense policy, group health care services plan, or group-type

20  self-insurance plan that provides protection or insurance

21  against hospital, medical, or surgical expenses delivered or

22  issued for delivery in this state, and the claim is submitted

23  to a secondary prepaid health plan or insurer and is

24  subsequently rejected, the provider has 60 calendar days from

25  the date the provider obtains the correct billing information

26  for the primary or secondary insurer or prepaid health plan to

27  submit the claim, regardless of any time periods for

28  submission of claims established by any applicable contract.

29  For the purposes of this subsection, "insurer" includes

30  persons contracting with preferred provider networks pursuant

31

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  1  to s. 627.6471 and exclusive provider networks pursuant to s.

  2  627.6472.

  3         (12)(a)  Without regard to any other remedy or relief

  4  to which a provider is entitled, any provider aggrieved by a

  5  violation of this section by a health maintenance organization

  6  may bring an action to enjoin a person who has violated, or is

  7  violating, this section. In any such action, the provider who

  8  has suffered a loss as a result of the violation may recover

  9  any amounts due the provider by the health maintenance

10  organization, including accrued interest, plus attorney's fees

11  and costs as provided in paragraph (b).

12         (b)  In any action arising out of a violation of this

13  section by a health maintenance organization in which the

14  health maintenance organization is found to have violated this

15  section, the provider, after judgment in the trial court and

16  after exhausting all appeals, if any, shall receive his or her

17  reasonable attorney's fees and costs from the health

18  maintenance organization.

19         (13)  The provisions of this section may not be waived,

20  voided, or nullified by contract.

21         Section 11.  Section 641.3156, Florida Statutes, is

22  amended to read:

23         641.3156  Treatment authorization; payment of claims.--

24         (1)  For purposes of this section, "authorization"

25  includes any requirement of a provider to notify a health

26  maintenance organization in advance of providing a covered

27  service, regardless of whether the actual terminology used by

28  the organization includes, but is not limited to,

29  preauthorization, precertification, notification, or any other

30  similar terminology.

31

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  1         (2)  A health maintenance organization that requires

  2  authorization for medical care and health care services shall

  3  provide to each contracted provider at the time a contract is

  4  signed a list of the medical care and health care services

  5  that require authorization and the authorization procedures

  6  used by the organization. A health maintenance organization

  7  that requires authorization for medical care and health care

  8  services shall provide to each noncontracted provider, not

  9  later than 10 working days after a request is made, a list of

10  the medical care and health care services that require

11  authorization and the authorization procedures used by the

12  organization. The list of medical care or health care services

13  that require authorization and the authorization procedures

14  used by the organization shall not be modified unless written

15  notice is provided at least 30 days in advance of any changes

16  to all subscribers, contracted providers, and noncontracted

17  providers who had previously requested a list of medical care

18  or health care services that require authorization.

19         (3)  Any claim for treatment that does not require an

20  authorization for a covered service that is ordered by a

21  contracted physician may not be denied. A health maintenance

22  organization must pay any hospital-service or referral-service

23  claim for treatment for an eligible subscriber which was

24  authorized by a provider empowered by contract with the health

25  maintenance organization to authorize or direct the patient's

26  utilization of health care services and which was also

27  authorized in accordance with the health maintenance

28  organization's current and communicated procedures, unless the

29  provider provided information to the health maintenance

30  organization with the willful intention to misinform the

31  health maintenance organization.

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  1         (4)(a)(2)  A claim for treatment may not be denied if a

  2  provider follows the health maintenance organization's

  3  authorization procedures and receives authorization for a

  4  covered service for an eligible subscriber, unless the

  5  provider provided information to the health maintenance

  6  organization with the willful intention to misinform the

  7  health maintenance organization.

  8         (b)  On receipt of a request from a provider for

  9  authorization pursuant to this section, the health maintenance

10  organization shall issue a determination indicating whether

11  the service or services are authorized. The determination must

12  be transmitted to the provider making the request in writing

13  no later than 8 hours after the request is made by the

14  provider. If the organization denies the request for an

15  authorization, the health maintenance organization must notify

16  the subscriber at the same time when notifying the provider

17  requesting the authorization. A health maintenance

18  organization that fails to respond to a request for an

19  authorization from a provider pursuant to this paragraph is

20  considered to have authorized the requested medical care or

21  health care service and payment may not be denied.

22         (5)  If the proposed medical care or health care

23  service or services involve an inpatient admission and the

24  health maintenance organization requires authorization as a

25  condition of payment, the health maintenance organization

26  shall issue a written or electronic authorization for the

27  total estimated length of stay for the admission.  If the

28  proposed medical care or health care service or services are

29  to be provided to a patient who is an inpatient in a health

30  care facility at the time the services are proposed and the

31  medical care or health care service requires an authorization,

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  1  the health maintenance organization shall issue a

  2  determination indicating whether the proposed services are

  3  authorized no later than 1 hour after the request by the

  4  health care provider. A health maintenance organization that

  5  fails to respond to such request within 1 hour is considered

  6  to have authorized the requested medical care or health care

  7  service and payment may not be denied.

  8         (6)(3)  Emergency services are subject to the

  9  provisions of s. 641.513 and are not subject to the provisions

10  of this section, including any inpatient admission required in

11  order to stabilize the patient pursuant to federal and state

12  law.

13         (7)  The provisions of this section may not be waived,

14  voided, or nullified by contract.

15         Section 12.  Subsection (4) of section 627.651, Florida

16  Statutes, is amended to read:

17         627.651  Group contracts and plans of self-insurance

18  must meet group requirements.--

19         (4)  This section does not apply to any plan which is

20  established or maintained by an individual employer in

21  accordance with the Employee Retirement Income Security Act of

22  1974, Pub. L. No. 93-406, or to a multiple-employer welfare

23  arrangement as defined in s. 624.437(1), except that a

24  multiple-employer welfare arrangement shall comply with ss.

25  627.419, 627.657, 627.6575, 627.6578, 627.6579, 627.6612,

26  627.66121, 627.66122, 627.6615, 627.6616, and 627.662(9)(6).

27  This subsection does not allow an authorized insurer to issue

28  a group health insurance policy or certificate which does not

29  comply with this part.

30         Section 13.  Effective October 16, 2002, section

31  627.647, Florida Statutes, is repealed.

                                  33

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 2002                 HB 293

    751-103B-02






  1         Section 14.  Except as otherwise provided herein, this

  2  act shall take effect October 1, 2002.

  3

  4            *****************************************

  5                          HOUSE SUMMARY

  6
      Includes preferred provider organizations within the
  7    definition of managed care organization and provides for
      filing unresolved internal dispute-resolution processes
  8    with a dispute-resolution organization. Provides for
      coordination of benefits under multiple health insurance
  9    policies regardless of time periods. Revises time of
      payment of claims provisions. Requires the Department of
10    Insurance to adopt insurance claim-filing rules
      consistent with federal standards and provides
11    requirements and procedures for payment or denial of
      claims. Entitles insureds and health maintenance
12    organization subscribers to prompt payment of claims for
      covered services. Requires health insurers and health
13    maintenance organizations to provide lists of medical
      care and health care services that require authorization
14    and provides procedural requirements for determination
      and issuance of authorizations for services. Revises
15    limitations on policies providing differing schedules of
      payments for preferred provider services and nonpreferred
16    provider services. Applies coordination of benefits,
      payment of claims, and treatment authorizations
17    provisions to group, blanket, and franchise health
      insurance. See bill for details.
18

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CODING: Words stricken are deletions; words underlined are additions.