CODING: Words stricken are deletions; words underlined are additions.
SENATE AMENDMENT
Bill No. CS for CS for SB 362, 1st Eng.
Amendment No. ___ Barcode 200974
CHAMBER ACTION
Senate House
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11 Senator Saunders moved the following amendment:
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13 Senate Amendment
14 On page 3, line 18, through
15 page 4, line 29, delete those lines
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17 and insert:
18 Section 1. Paragraph (a) of subsection (1), paragraph
19 (c) of subsection (2), and subsections (3) and (4) of section
20 408.7057, Florida Statutes, are amended, and paragraphs (e)
21 and (f) are added to subsection (2) of that section, to read:
22 408.7057 Statewide provider and managed care
23 organization claim dispute resolution program.--
24 (1) As used in this section, the term:
25 (a) "Managed care organization" means a health
26 maintenance organization or a prepaid health clinic certified
27 under chapter 641, a prepaid health plan authorized under s.
28 409.912, or an exclusive provider organization certified under
29 s. 627.6472, a preferred provider organization under s.
30 627.6471, or a health insurer licensed pursuant to chapter
31 627.
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SENATE AMENDMENT
Bill No. CS for CS for SB 362, 1st Eng.
Amendment No. ___ Barcode 200974
1 (2)
2 (c) Contracts entered into or renewed on or after
3 October 1, 2000, may require exhaustion of an internal
4 dispute-resolution process as a prerequisite to the submission
5 of a claim by a provider, or health maintenance organization,
6 or health insurer to the resolution organization when the
7 dispute-resolution program becomes effective.
8 (e) The resolution organization shall require the
9 managed care organization or provider submitting the claim
10 dispute to submit any supporting documentation to the
11 resolution organization within 15 days after receipt by the
12 managed care organization or provider of a request from the
13 resolution organization for documentation in support of the
14 claim dispute. Failure to submit the supporting documentation
15 within such time period shall result in the dismissal of the
16 submitted claim dispute.
17 (f) The resolution organization shall require the
18 respondent in the claim dispute to submit all documentation in
19 support of its position within 15 days after receiving a
20 request from the resolution organization for supporting
21 documentation. The resolution organization may extend the time
22 if appropriate. Failure to submit the supporting documentation
23 within such time period shall result in a default against the
24 managed care organization or provider. In the event of such a
25 default, the resolution organization shall issue its written
26 recommendation to the agency that a default be entered against
27 the defaulting entity. The written recommendation shall
28 include a recommendation to the agency that the defaulting
29 entity shall pay the entity submitting the claim dispute the
30 full amount of the claim dispute, plus all accrued interest.
31 (3) The agency shall adopt rules to establish a
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10:00 AM 03/06/02 s0362c2b-25j01
SENATE AMENDMENT
Bill No. CS for CS for SB 362, 1st Eng.
Amendment No. ___ Barcode 200974
1 process to be used by the resolution organization in
2 considering claim disputes submitted by a provider or managed
3 care organization which must include the issuance by the
4 resolution organization of a written recommendation, supported
5 by findings of fact, to the agency within 60 days after the
6 requested information is received by the resolution
7 organization within the timeframes specified by the resolution
8 organization. The review time may not exceed 90 days following
9 receipt of the initial claim dispute submission by the
10 resolution organization.
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