Full Text of SB0493 102nd General Assembly
SB0493 102ND GENERAL ASSEMBLY
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
Introduced 2/23/2021, by Sen. Dave Syverson
SYNOPSIS AS INTRODUCED:
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
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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
This Act may be cited as the
Uniform Electronic Transactions in Dental Care Billing Act.
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.
Except as may be otherwise
specifically provided, this Act applies to all dental plan
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
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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.
Uniform electronic claims and eligibility
(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
(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
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by the dental plan carrier.
Rules; modification of rules.
(a) The Department shall adopt rules as necessary to
implement this Act and may establish exemptions to this Act by
(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.
Compliance and investigations.
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
(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.
This Act takes effect upon