96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010
HB5107


 
Introduced 1/29/2010, by Rep. Greg Harris
 
SYNOPSIS AS INTRODUCED:
 		





 


  



215 ILCS 5/368d










     Amends the Illinois Insurance Code. In the provision concerning recoupment, provides that no recoupment or offset may be requested or withheld from future payments 180 or more days after the original payment is made. Provides that no contract between an insurer and a health care professional or health care provider may provide for recoupments in violation of the provision concerning recoupment.
  















LRB096 18006 RPM 33378 b

















 


 


A BILL FOR









 




  






HB5107

LRB096 18006 RPM 33378 b





  
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    AN ACT concerning insurance.
  
 
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    Be it enacted by the People of the State of Illinois,
 
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represented in the General Assembly:
  
 
 
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    Section 5. The Illinois Insurance Code is amended  by 
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changing Section 368d as follows:
 



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    (215 ILCS 5/368d)



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    Sec. 368d. Recoupments. 

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    (a) A health care professional or health care provider 
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shall be provided a
remittance advice, which must include an 
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explanation of a
recoupment or
offset taken by an insurer, 
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health maintenance organization,
independent practice 
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association, or physician hospital
organization, if any. The 
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recoupment explanation shall, at a minimum, include
the name
of 
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the patient; the date of service; the service code or if no 
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service code is
available a service description;
the recoupment 
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amount; and the reason for the recoupment or offset. In

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addition,
an insurer,
health maintenance organization, 
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independent
practice association, or physician
hospital 
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organization shall provide with the remittance advice a 
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telephone
number or mailing address to initiate an appeal of 
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the recoupment or offset.

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    (b) It is not a recoupment when a health care professional 
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or health care
provider
is paid an amount prospectively or 
 


 






HB5107
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LRB096 18006 RPM 33378 b




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concurrently under a contract with an
insurer, health

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maintenance organization, independent practice
association, or 
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physician
hospital
organization that requires a retrospective 
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reconciliation based upon specific
conditions
outlined in the 
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contract.
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    (c) No recoupment or offset may be requested or withheld 
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from future payments 180 or more days after the original 
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payment is made. No contract between an insurer and a health 
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care professional or health care provider may provide for 
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recoupments in violation of this Section. 

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(Source: P.A. 93-261, eff. 1-1-04.)