SB0493eng 102ND GENERAL ASSEMBLY

SB0493 Engrossed LRB102 10174 BMS 15496 b

AN ACT concerning regulation.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 1. Short title. This Act may be cited as the Uniform Electronic Transactions in Dental Care Billing Act.

Section 5. Purpose. The purpose of this Act is to standardize the forms used in the billing and reimbursement of dental care, reduce the number of forms used, increase efficiency in the reimbursement of dental care through standardization, and encourage the use of and prescribe a timetable for implementation of electronic data interchange of dental care expenses and reimbursement.

Section 10. Applicability. Except as may be otherwise specifically provided, this Act applies to all dental plan carriers.

Section 15. Definitions. As used in this Act:

"Department" means the Department of Insurance.

"Director" means the Director of Insurance.

"Dental care provider" means a dentist who bills for services in Illinois.

"Dental plan carrier" means an entity subject to the insurance laws and regulations of this State or subject to the jurisdiction of the Director that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of dental care services, including an accident and health insurance company, a health maintenance organization, a limited health service organization, a dental service plan corporation, a health services plan corporation, a voluntary health services plan, or any other entity providing a plan of dental insurance, dental benefits, or dental health care services.

Section 20. Uniform electronic claims and eligibility transactions required.

(a) Beginning January 1, 2025, no dental plan carrier is required to accept from a dental care provider eligibility for a dental plan transaction or dental care claims or equivalent encounter information transaction except as provided in this Act.

(b) All dental plan carriers and dental care providers must exchange claims and eligibility information electronically using the standard electronic data interchange transactions for claims submissions, payments, and verification of benefits required under the Health Insurance Portability and Accountability Act in order to be compensable by the dental plan carrier.

Section 25. Rules; modification of rules.

(a) The Department shall adopt rules as necessary to implement this Act and may establish exemptions to this Act by rule.

(b) A dental plan carrier or dental care provider may not add to or modify the uniform electronic claims and eligibility requirements adopted by the Department.

Section 99. Effective date. This Act takes effect upon becoming law.