Illinois General Assembly - Full Text of SB0493
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Full Text of SB0493  102nd General Assembly

SB0493 102ND GENERAL ASSEMBLY

  
  

 


 
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.


LRB102 10174 BMS 15496 b

 

 

A BILL FOR

 

SB0493LRB102 10174 BMS 15496 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 Dental Care Billing Act.
 
6    Section 5. Purpose. The purpose of this Act is to
7standardize the forms used in the billing and reimbursement of
8dental care, reduce the number of forms used, increase
9efficiency in the reimbursement of dental care through
10standardization, and encourage the use of and prescribe a
11timetable for implementation of electronic data interchange of
12dental care expenses and reimbursement.
 
13    Section 10. Applicability. Except as may be otherwise
14specifically provided, this Act applies to all dental 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    "Dental care provider" means a dentist who bills for
20services in Illinois.
21    "Dental plan carrier" means an entity subject to the

 

 

SB0493- 2 -LRB102 10174 BMS 15496 b

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

 

 

SB0493- 3 -LRB102 10174 BMS 15496 b

1by the dental plan carrier.
 
2    Section 25. Rules; modification of rules.
3    (a) The Department shall adopt rules as necessary to
4implement this Act and may establish exemptions to this Act by
5rule.
6    (b) A dental plan carrier or dental care provider may not
7add to or modify the uniform electronic claims and eligibility
8requirements adopted by the Department.
 
9    Section 30. Compliance and investigations. The Director
10has the right to investigate complaints filed under this Act.
11Complaints filed under this Section must:
12        (1) be filed in writing, either on paper or
13    electronically;
14        (2) name the person that is the subject of the
15    complaint and describe the acts or omissions believed to
16    be in violation of this Act; and
17        (3) be filed within 180 days after the complainant
18    knew or should have known that the act or omission
19    complained of occurred.
20    The Director may prescribe additional procedures for the
21filing of complaints as required to satisfy the requirements
22of this Section.
 
23    Section 99. Effective date. This Act takes effect upon
24becoming law.