Bill Text: IL HB0468 | 2009-2010 | 96th General Assembly | Introduced
Bill Title: Amends the Illinois Insurance Code. Provides that when a person presents a benefits information card, if the health care professional or health care provider has a participation contract with the insurer, health maintenance organization, or other entity identified on the card, then the health care professional or health care provider shall submit its claim for services covered under the policy within the time frame specified by the insurer or other entity, but not later than one year after the last date that services have been provided to the insured person. Provides that the health care professional or health care provider may not discriminate against the insured person based upon the cause of that person's sickness or accidental injury. If the health care professional or health care provider fails to submit its claim within the time frame provided for under the Act, the health care professional or health care provider may not seek remittance from the insured person. Effective immediately.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2009-03-13 - Rule 19(a) / Re-referred to Rules Committee [HB0468 Detail]
Download: Illinois-2009-HB0468-Introduced.html
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1 | AN ACT concerning insurance.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Insurance Code is amended by | |||||||||||||||||||
5 | changing Section 368c as follows:
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6 | (215 ILCS 5/368c)
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7 | Sec. 368c. Remittance advice and procedures.
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8 | (a) A remittance advice shall be furnished to a health care | |||||||||||||||||||
9 | professional or
health
care provider that identifies the | |||||||||||||||||||
10 | disposition of each claim. The remittance
advice shall identify | |||||||||||||||||||
11 | the services billed; the patient responsibility, if any;
the | |||||||||||||||||||
12 | actual payment, if any, for the services billed; and the reason | |||||||||||||||||||
13 | for any
reduction to the amount for
which the claim was | |||||||||||||||||||
14 | submitted. For any reductions to the amount for which the
claim | |||||||||||||||||||
15 | was submitted, the remittance shall identify any withholds and | |||||||||||||||||||
16 | the reason
for any denial or reduction.
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17 | A remittance advice for capitation or prospective payment | |||||||||||||||||||
18 | arrangements shall
be
furnished to a health care professional | |||||||||||||||||||
19 | or health care provider pursuant to a
contract with
an insurer, | |||||||||||||||||||
20 | health maintenance organization,
independent practice | |||||||||||||||||||
21 | association,
or
physician hospital organization in accordance | |||||||||||||||||||
22 | with the terms of the contract.
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23 | (b) When health care services are provided by a |
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1 | non-participating
health care
professional or health care | ||||||
2 | provider, an insurer, health maintenance
organization,
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3 | independent practice association, or physician hospital | ||||||
4 | organization may pay
for covered
services either to a patient | ||||||
5 | directly or to the non-participating health care
professional | ||||||
6 | or
health care provider.
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7 | (c) When a person presents a
benefits information card,
a | ||||||
8 | health care professional or health care provider shall make a | ||||||
9 | good faith
effort
to inform the
person if the
health care | ||||||
10 | professional or health care provider has a participation | ||||||
11 | contract
with the
insurer,
health maintenance organization, or | ||||||
12 | other
entity identified on the card. If the health care | ||||||
13 | professional or health care provider has a participation | ||||||
14 | contract, then the health care professional or health care | ||||||
15 | provider shall submit its claim for services covered under the | ||||||
16 | policy within the time frame specified by the insurer, health | ||||||
17 | maintenance organization, or other
entity, but not later than | ||||||
18 | one year after the last date that services have been provided | ||||||
19 | to the insured person. The health care professional or health | ||||||
20 | care provider may not discriminate against the insured person | ||||||
21 | based upon the cause of that person's sickness or accidental | ||||||
22 | injury. If the health care professional or health care provider | ||||||
23 | fails to submit its claim within the time frame provided for | ||||||
24 | under this subsection (c), the health care professional or | ||||||
25 | health care provider may not seek remittance from the insured | ||||||
26 | person.
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1 | (Source: P.A. 93-261, eff. 1-1-04.)
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2 | Section 99. Effective date. This Act takes effect upon | ||||||
3 | becoming law.
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