General Assembly Raised Bill No. 6381
January Session, 2013 LCO No. 2627
*02627_______INS*
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
General Assembly
Raised Bill No. 6381
January Session, 2013
LCO No. 2627
*02627_______INS*
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
(INS)
AN ACT CONCERNING HEALTH INSURANCE CLAIM FORMS AND UNIFORM TREATMENT AUTHORIZATION FORMS FOR MENTAL HEALTH SERVICES.
Be it enacted by the Senate and House of Representatives in General Assembly convened:
Section 1. Subsections (a) and (b) of section 38a-477 of the general statutes are repealed and the following is substituted in lieu thereof (Effective October 1, 2013):
(a) Except where there is an agreement to the contrary between a third-party payer and the health care provider, as defined in section 19a-17b, all health care providers shall submit all third-party claims for payment on the current standard Health Care Financing Administration Fifteen Hundred (HCFA1500) health insurance claim form or its successor, or in the case of a hospital or other health care institution, a Health Care Financing Administration UB-92 health insurance claim form or its successor, or in accordance with other forms [which] that may be prescribed by the Insurance Commissioner. With respect to the Health Care Financing Administration Fifteen Hundred health insurance claim form or its successor or other form prescribed by the commissioner for third-party claims for payment, a health care provider shall be allowed to use a National Provider Identifier assigned to such provider by the Centers for Medicare and Medicaid Services' National Plan and Provider Enumeration System in lieu of such provider's federal tax identification number.
(b) For any claim submitted to an insurer on the current standard Health Care Financing Administration Fifteen Hundred health insurance claim form or its successor, if the following information is completed and received by the insurer, the claim may not be deemed to be deficient in the information needed for filing a claim for processing pursuant to subparagraph (B) of subdivision (15) of section 38a-816.
T1 Item Number Item Description
T2 1a Insured's identification number
T3 2 Patient's name
T4 3 Patient's birth date and sex
T5 4 Insured's name
T6 10a Patient's condition - employment
T7 10b Patient's condition - auto accident
T8 10c Patient's condition - other accident
T9 11 Insured's policy group number
T10 (if provided on identification card)
T11 11d Is there another health benefit plan?
T12 17a Identification number of referring physician or
T13 advanced practice registered nurse
T14 (if required by insurer)
T15 21 Diagnosis
T16 24A Dates of service
T17 24B Place of service
T18 24D Procedures, services or supplies
T19 24E Diagnosis code
T20 24F Charges
T21 25 Federal tax identification number
T22 or National Provider Identifier
T23 28 Total charge
T24 31 Signature of physician, advanced practice
T25 registered nurse or supplier with date
T26 33 Physician's, advanced practice registered nurse's
T27 or supplier's billing name,
T28 address, zip code & telephone number
T1
Item Number
Item Description
T2
1a
Insured's identification number
T3
2
Patient's name
T4
3
Patient's birth date and sex
T5
4
Insured's name
T6
10a
Patient's condition - employment
T7
10b
Patient's condition - auto accident
T8
10c
Patient's condition - other accident
T9
11
Insured's policy group number
T10
(if provided on identification card)
T11
11d
Is there another health benefit plan?
T12
17a
Identification number of referring physician or
T13
advanced practice registered nurse
T14
(if required by insurer)
T15
21
Diagnosis
T16
24A
Dates of service
T17
24B
Place of service
T18
24D
Procedures, services or supplies
T19
24E
Diagnosis code
T20
24F
Charges
T21
25
Federal tax identification number
T22
or National Provider Identifier
T23
28
Total charge
T24
31
Signature of physician, advanced practice
T25
registered nurse or supplier with date
T26
33
Physician's, advanced practice registered nurse's
T27
or supplier's billing name,
T28
address, zip code & telephone number
Sec. 2. (Effective from passage) Not later than January 1, 2014, the Commissioner of Public Health, in consultation with the Insurance Commissioner, the Commissioner of Mental Health and Addiction Services, the Attorney General and the Healthcare Advocate, shall develop a uniform treatment authorization form for mental health services. Such form shall (1) be used by health care providers and hospitals in this state to obtain patient authorization and information for the provision of mental health services, (2) meet, at a minimum, privacy standards set forth in state and federal privacy laws, including, but not limited to, the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended from time to time, and any regulations adopted thereunder, and (3) comply with state and federal mental health parity laws. Not later than February 12, 2014, the Commissioner of Public Health shall submit any proposed legislation the Commissioner of Public Health deems necessary to implement the use of such form to the joint standing committee of the General Assembly having cognizance of matters relating to public health.
This act shall take effect as follows and shall amend the following sections:
Section 1 October 1, 2013 38a-477(a) and (b)
Sec. 2 from passage New section
This act shall take effect as follows and shall amend the following sections:
Section 1
October 1, 2013
38a-477(a) and (b)
Sec. 2
from passage
New section
Statement of Purpose:
To allow health care providers to use a National Provider Identifier in lieu of a federal tax identification number on an HCFA1500 payment claim form, and to require the development of a uniform treatment authorization form for mental health services.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]