Sen. Dave Syverson
Filed: 4/9/2021
 
 


 




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1
AMENDMENT TO SENATE BILL 493 




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 
15carriers.

 
 
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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 
23Act.

24 (b) All dental plan carriers and dental care providers 
 
 
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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 
10rule.

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.".