(215 ILCS 5/368c)
Sec. 368c.
Remittance advice and procedures.
(a) A remittance advice shall be furnished to a health care professional or
health
care provider that identifies the disposition of each claim. The remittance
advice shall identify the services billed; the patient responsibility, if any;
the actual payment, if any, for the services billed; and the reason for any
reduction to the amount for
which the claim was submitted. For any reductions to the amount for which the
claim was submitted, the remittance shall identify any withholds and the reason
for any denial or reduction.
A remittance advice for capitation or prospective payment arrangements shall
be
furnished to a health care professional or health care provider pursuant to a
contract with
an insurer, health maintenance organization,
independent practice association,
or
physician hospital organization in accordance with the terms of the contract.
(b) When health care services are provided by a non-participating
health care
professional or health care provider, an insurer, health maintenance
organization,
independent practice association, or physician hospital organization may pay
for covered
services either to a patient directly or to the non-participating health care
professional or
health care provider.
(c) When a person presents a
benefits information card,
a health care professional or health care provider shall make a good faith
effort
to inform the
person if the
health care professional or health care provider has a participation contract
with the
insurer,
health maintenance organization, or other
entity identified on the card.
(Source: P.A. 93-261, eff. 1-1-04.)
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