SB0493 102ND GENERAL ASSEMBLY

LRB102 10174 BMS 15496 b

102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB0493

Introduced 2/23/2021, by Sen. Dave Syverson

SYNOPSIS AS INTRODUCED:

New Act

Creates the Uniform Electronic Transactions in Dental Care Billing Act. Requires all dental plan carriers and dental care providers to exchange claims and eligibility information electronically using the 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 dental plan carrier. Provides that no dental plan carrier or dental care provider may add to or modify the uniform electronic claims and eligibility requirements adopted by the Department. Provides that the Act applies to all dental 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 rule. Defines terms. Effective immediately.

A BILL FOR

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Uniform Electronic Transactions in Dental Care Billing Act.

Section 5. Purpose. The purpose of this Act is to standardize the forms used in the billing and reimbursement of dental care, reduce the number of forms used, increase efficiency in the reimbursement of dental care through standardization, and encourage the use of and prescribe a timetable for implementation of electronic data interchange of dental care expenses and reimbursement.

Section 10. Applicability. Except as may be otherwise specifically provided, this Act applies to all dental plan carriers.

Section 15. Definitions. As used in this Act:

"Department" means the Department of Insurance.

"Director" means the Director of Insurance.

"Dental care provider" means a dentist who bills for services in Illinois.

"Dental plan carrier" means an entity subject to the insurance laws and regulations of this State or subject to the jurisdiction of the Director that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of dental care services, including an accident and health insurance company, a health maintenance organization, a limited health service organization, a dental service plan corporation, a health services plan corporation, a voluntary health services plan, or any other entity providing a plan of dental insurance, dental benefits, or dental health care services. "Dental plan carrier" includes employee or employer self-insured benefit plans under the federal Employee Retirement Income Security Act of 1974.

Section 20. Uniform electronic claims and eligibility transactions required.

(a) Beginning January 1, 2025, no dental plan carrier is required to accept from a dental care provider eligibility for a dental plan transaction or dental care claims or equivalent encounter information transaction except as provided in this Act.

(b) All dental plan carriers and dental care providers must exchange claims and eligibility information electronically using the 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 dental plan carrier.

Section 25. Rules; modification of rules.

(a) The Department shall adopt rules as necessary to implement this Act and may establish exemptions to this Act by rule.

(b) A dental plan carrier or dental care provider may not add to or modify the uniform electronic claims and eligibility requirements adopted by the Department.

Section 30. Compliance and investigations. The Director has the right to investigate complaints filed under this Act. Complaints filed under this Section must:

(1) be filed in writing, either on paper or electronically;

(2) name the person that is the subject of the complaint and describe the acts or omissions believed to be in violation of this Act; and

(3) be filed within 180 days after the complainant knew or should have known that the act or omission complained of occurred.

The Director may prescribe additional procedures for the filing of complaints as required to satisfy the requirements of this Section.

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