SB 138 Creates standards for predetermination of health care benefits requests and responses
Sponsor: Sater
LR Number: 0443S.01I Fiscal Notes
Committee: Health and Pensions
Last Action: 5/12/2017 - Informal Calendar S Bills for Perfection--SB 138-Sater Journal Page:
Title: Calendar Position:
Effective Date: August 28, 2017

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Current Bill Summary

SB 138 – This act requires health benefit plans that receive electronic health care predetermination requests from health care providers to provide the requesting health care provider information on the amounts of expected benefits coverage on the procedures specified in the request. The act also requires health care providers and health benefit plans to comply with defined administrative simplification procedures when submitting and replying to health care predetermination requests. This act requires a health benefit plan's response to be returned in the same manner as the request was received. This act also requires that a health care clearinghouse that contracts with a health care provider shall complete the required predetermination transactions if requested by the health care provider. If the Health Insurance Portability Act of 1996 (HIPAA) mandated electronic transactions are modified to include predetermination transactions, this act shall not apply to health benefit plans that provide the information pursuant to HIPAA. This act specifies that the collection of any payment prior to receiving the health benefit services is not prohibited by the act. This act also exempts supplemental insurance policies from the provisions of the act.

This act is effective July 1, 2018.

This act is substantially similar to SCS/SB 1023 (2016) and HB 2477 (2016), and similar to provisions in HCS/HB 2269 (2016).