Insurance Committee
Filed: 3/9/2010
 
 

 




 

 		












09600HB5107ham001

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AMENDMENT TO HOUSE BILL 5107




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    AMENDMENT NO. ______. Amend House Bill 5107 by replacing 
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everything after the enacting clause with the following:

 
 
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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

 


 






09600HB5107ham001
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LRB096 18006 RPM 37703 a




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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 
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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 366 or more days after the original 
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payment is made, except in cases where a court, government 
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administrative agency, or other tribunal has made a formal 
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adjudication of fraud. No contract between an insurer and a 
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health care professional or health care provider may provide 
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for recoupments in violation of this Section. 

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