SB 138 - Sater, David
Creates standards for predetermination of health care benefits requests and responses
Bill Details
Sponsor
LR Number
0443S.01I
Title
SB 138
House Handler
N/A
Journal Page
N/A
Effective Date
August 28, 2017
Committee
Current Status
Informal Calendar S Bills for Perfection--SB 138-Sater
Quick Links
Amendments
No amendments available
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).
ERIC VANDER WEERD