97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB3812

 

Introduced 10/5/2011, by Rep. Daniel J. Burke

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/368c

    Amends the Illinois Insurance Code. Provides that prior to providing care to a person, a health care professional or health care provider shall verify whether that health care professional or health care provider is in the network of participating providers whose services are covered by the person's policy of accident and health insurance and shall notify the person of this information.


LRB097 13098 RPM 57604 b

 

 

A BILL FOR

 

HB3812LRB097 13098 RPM 57604 b

1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 368c as follows:
 
6    (215 ILCS 5/368c)
7    Sec. 368c. Remittance advice and procedures.
8    (a) A remittance advice shall be furnished to a health care
9professional or health care provider that identifies the
10disposition of each claim. The remittance advice shall identify
11the services billed; the patient responsibility, if any; the
12actual payment, if any, for the services billed; and the reason
13for any reduction to the amount for which the claim was
14submitted. For any reductions to the amount for which the claim
15was submitted, the remittance shall identify any withholds and
16the reason for any denial or reduction.
17    A remittance advice for capitation or prospective payment
18arrangements shall be furnished to a health care professional
19or health care provider pursuant to a contract with an insurer,
20health maintenance organization, independent practice
21association, or physician hospital organization in accordance
22with the terms of the contract.
23    (b) When health care services are provided by a

 

 

HB3812- 2 -LRB097 13098 RPM 57604 b

1non-participating health care professional or health care
2provider, an insurer, health maintenance organization,
3independent practice association, or physician hospital
4organization may pay for covered services either to a patient
5directly or to the non-participating health care professional
6or health care provider.
7    (c) When a person presents a benefits information card, a
8health care professional or health care provider shall make a
9good faith effort to inform the person if the health care
10professional or health care provider has a participation
11contract with the insurer, health maintenance organization, or
12other entity identified on the card.
13    (d) Notwithstanding any other provision of this Section,
14prior to providing care to a person, a health care professional
15or health care provider shall verify whether that health care
16professional or health care provider is in the network of
17participating providers whose services are covered by the
18person's policy of accident and health insurance and shall
19notify the person of this information.
20(Source: P.A. 93-261, eff. 1-1-04.)