101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB3120

 

Introduced 2/6/2020, by Sen. Dave Syverson

 

SYNOPSIS AS INTRODUCED:
 
New Act

    Creates the Uniform Electronic Transactions in Health Care Billing Act. Requires all health plan carriers and health care providers to exchange claims and eligibility information electronically using the companion guides, implementation guides, timelines, and standard electronic data interchange transactions for claims submissions, payments, and verification of benefits required under the Health Insurance Portability and Accountability Act in order to be compensable by the health plan carrier. Provides that no health plan carrier or health care provider may add to or modify the uniform companion guides. Provides that the Act applies to all health plan carriers. Grants the Director of Insurance the right to investigate complaints filed under the Act. Sets forth criteria for complaints filed under the Act. Requires the Department of Insurance to adopt rules, and allows the Department to establish exemptions to the Act by regulation. Defines terms. Effective immediately.


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A BILL FOR

 

SB3120LRB101 19599 BMS 69075 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be cited as the
5Uniform Electronic Transactions in Health Care Billing Act.
 
6    Section 5. Purpose. The purpose of this Act is to
7standardize the forms used in the billing and reimbursement of
8health care, reduce the number of forms used, increase
9efficiency in the reimbursement of health care through
10standardization, and encourage the use of and prescribe a
11timetable for implementation of electronic data interchange of
12health care expenses and reimbursement.
 
13    Section 10. Applicability. Except as may be otherwise
14specifically provided, this Act applies to all health plan
15carriers.
 
16    Section 15. Definitions. As used in this Act:
17    "Department" means the Department of Insurance.
18    "Director" means the Director of Insurance.
19    "Health care provider" means a physician, a dentist, or any
20other licensed health care provider who bills for services in
21Illinois.

 

 

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1    "Health plan carrier" means an entity subject to the
2insurance laws and regulations of this State or subject to the
3jurisdiction of the Director that contracts or offers to
4contract to provide, deliver, arrange for, pay for, or
5reimburse any of the costs of health care services, including
6an accident and health insurance company, a health maintenance
7organization, a limited health service organization, a dental
8service plan corporation, a health services plan corporation,
9or any other entity providing a plan of health insurance,
10dental benefits, or dental health care services. "Health plan
11carrier" includes employee or employer self-insured benefit
12plans under the federal Employee Retirement Income Security Act
13of 1974.
 
14    Section 20. Uniform electronic claims and eligibility
15transactions required.
16    (a) Beginning January 1, 2025, no health plan carrier is
17required to accept from a health care provider eligibility for
18a health plan transaction or health care claims or equivalent
19encounter information transaction except as provided in this
20Act.
21    (b) All health plan carriers and health care providers must
22exchange claims and eligibility information electronically
23using the companion guides, implementation guides, timelines,
24and standard electronic data interchange transactions for
25claims submissions, payments, and verification of benefits

 

 

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1required under the Health Insurance Portability and
2Accountability Act in order to be compensable by the health
3plan carrier.
 
4    Section 25. Rules; modification of guides.
5    (a) The Department shall adopt rules as necessary to
6implement this Act and may establish exemptions to this Act by
7regulation.
8    (b) A health plan carrier or health care provider may not
9add to or modify the uniform companion guides adopted by the
10Department.
 
11    Section 30. Compliance and investigations. The Director
12has the right to investigate complaints filed under this Act.
13Complaints filed under this Section must:
14        (1) be filed in writing, either on paper or
15    electronically;
16        (2) name the person that is the subject of the
17    complaint and describe the acts or omissions believed to be
18    in violation of this Act; and
19        (3) be filed within 180 days after the complainant knew
20    or should have known that the act or omission complained of
21    occurred.
22    The Director may prescribe additional procedures for the
23filing of complaints as required to satisfy the requirements of
24this Section.
 

 

 

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1    Section 99. Effective date. This Act takes effect upon
2becoming law.