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


Sen. Dave Syverson

Filed: 4/9/2021





10200SB0493sam001LRB102 10174 BMS 24832 a


2    AMENDMENT NO. ______. Amend Senate Bill 493 by replacing
3everything after the enacting clause with the following:
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



10200SB0493sam001- 2 -LRB102 10174 BMS 24832 a

1    Section 15. Definitions. As used in this Act:
2    "Department" means the Department of Insurance.
3    "Director" means the Director of Insurance.
4    "Dental care provider" means a dentist who bills for
5services in Illinois.
6    "Dental plan carrier" means an entity subject to the
7insurance laws and regulations of this State or subject to the
8jurisdiction of the Director that contracts or offers to
9contract to provide, deliver, arrange for, pay for, or
10reimburse any of the costs of dental care services, including
11an accident and health insurance company, a health maintenance
12organization, a limited health service organization, a dental
13service plan corporation, a health services plan corporation,
14a voluntary health services plan, or any other entity
15providing a plan of dental insurance, dental benefits, or
16dental health care services.
17    Section 20. Uniform electronic claims and eligibility
18transactions required.
19    (a) Beginning January 1, 2025, no dental plan carrier is
20required to accept from a dental care provider eligibility for
21a dental plan transaction or dental care claims or equivalent
22encounter information transaction except as provided in this
24    (b) All dental plan carriers and dental care providers



10200SB0493sam001- 3 -LRB102 10174 BMS 24832 a

1must exchange claims and eligibility information
2electronically using the standard electronic data interchange
3transactions for claims submissions, payments, and
4verification of benefits required under the Health Insurance
5Portability and Accountability Act in order to be compensable
6by the dental plan carrier.
7    Section 25. Rules; modification of rules.
8    (a) The Department shall adopt rules as necessary to
9implement this Act and may establish exemptions to this Act by
11    (b) A dental plan carrier or dental care provider may not
12add to or modify the uniform electronic claims and eligibility
13requirements adopted by the Department.
14    Section 99. Effective date. This Act takes effect upon
15becoming law.".