SB0493 EnrolledLRB102 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
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



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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.
11    Section 20. Uniform electronic claims and eligibility
12transactions required.
13    (a) Beginning January 1, 2025, no dental plan carrier is
14required to accept from a dental care provider eligibility for
15a dental plan transaction or dental care claims or equivalent
16encounter information transaction except as provided in this
18    (b) All dental plan carriers and dental care providers
19must exchange claims and eligibility information
20electronically using the standard electronic data interchange
21transactions for claims submissions, payments, and
22verification of benefits required under the Health Insurance
23Portability and Accountability Act in order to be compensable
24by the dental plan carrier.



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1    Section 25. Rules; modification of rules.
2    (a) The Department shall adopt rules as necessary to
3implement this Act and may establish exemptions to this Act by
5    (b) A dental plan carrier or dental care provider may not
6add to or modify the uniform electronic claims and eligibility
7requirements adopted by the Department.
8    Section 99. Effective date. This Act takes effect upon
9becoming law.