HB 1231 2025
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to insurance claims payments to 2
physicians; amending ss. 627.6131 and 641.315, F.S.; 3
prohibiting contracts between certain physicians and 4
health insurers and health maintenance organizations, 5
respectively, from specifying credit card payments to 6
physicians as the only acceptable method for payments; 7
authorizing use of electronic funds transfers by 8
health insurers and health maintenance organization s, 9
respectively, for payments to physicians under certain 10
circumstances; providing notification requirements; 11
prohibiting health insurers and health maintenance 12
organizations, respectively, from charging fees for 13
automated clearinghouse transfers as claims payments 14
to physicians; providing an exception; providing 15
applicability; prohibiting health insurers and health 16
maintenance organizations, respectively, from denying 17
claims subsequently submitted by physicians for 18
procedures that were included in prior au thorizations; 19
providing exceptions; providing applicability; 20
providing an effective date. 21
22
Be It Enacted by the Legislature of the State of Florida: 23
24
Section 1. Subsections (20) and (21) of section 627.6131, 25
HB 1231 2025
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
Florida Statutes, are amended to read: 26
627.6131 Payment of claims. — 27
(20)(a) A contract between a health insurer and a dentist 28
licensed under chapter 466 or a physician licensed under chapter 29
458 or chapter 459 for the provision of services to an insured 30
may not specify credit card payment as the only acceptable 31
method for payments from the health insurer to the dentist or 32
physician. 33
(b) When a health insurer employs the method of claims 34
payment to a dentist or physician through electronic funds 35
transfer, including, but not limited to, virtu al credit card 36
payment, the health insurer shall notify the dentist or 37
physician as provided in this paragraph and obtain the dentist's 38
or physician's consent before employing the electronic funds 39
transfer. The dentist's or physician's consent described in this 40
paragraph applies to the dentist's or physician's entire 41
practice. For the purpose of this paragraph, the dentist's or 42
physician's consent, which may be given through e -mail, must 43
bear the signature of the dentist or physician. Such signature 44
includes an electronic or digital signature if the form of 45
signature is recognized as a valid signature under applicable 46
federal law or state contract law or an act that demonstrates 47
express consent, including, but not limited to, checking a box 48
indicating consent. The health insurer or the dentist or 49
physician may not require that a dentist's or physician's 50
HB 1231 2025
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
consent as described in this paragraph be made on a patient -by-51
patient basis. The notification provided by the health insurer 52
to the dentist or physician must include all of the following: 53
1. The fees, if any, associated with the electronic funds 54
transfer. 55
2. The available methods of payment of claims by the 56
health insurer, with clear instructions to the dentist or 57
physician on how to select an alternative payment method. 58
(c) A health insurer that pays a claim to a dentist or 59
physician through automated clearinghouse transfer may not 60
charge a fee solely to transmit the payment to the dentist or 61
physician unless the dentist or physician has consented to the 62
fee. 63
(d) This subsection applies to all contracts: 64
1. Between a health insurer and a dentist which are 65
delivered, issued, or renewed on or after January 1, 2025. 66
2. Between a health insurer and a physician which are 67
delivered, issued, or renewed on or after January 1, 2026. 68
(e) The office has all rights and powers to enforce this 69
subsection as provided by s. 624.307. 70
(f) The commission may adopt rules to implement this 71
subsection. 72
(21)(a) A health insurer may not deny any claim 73
subsequently submitted by a dentist licensed under chapter 466 74
or a physician licensed under chapter 458 or chapter 459 for 75
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
procedures specifically included in a prior authorization unless 76
at least one of the following circumstances applies for each 77
procedure denied: 78
1. Benefit limitations, such as annual maximums and 79
frequency limitations not applicable at the time of the prior 80
authorization, are reached subsequent to issuance of the prior 81
authorization. 82
2. The documentation provided by the person submitting the 83
claim fails to support the claim as originally authorized. 84
3. Subsequent to the issuance of the prior authorization, 85
new procedures are provided to the patient or a change in the 86
condition of the patient occurs such that the prior authorized 87
procedure would no longer be considered medically necessary, 88
based on the prevailing standard of care. 89
4. Subsequent to the issuance of the prior authorization, 90
new procedures are provided to the patient or a change in the 91
patient's condition occurs such that the prior a uthorized 92
procedure would at that time have required disapproval pursuant 93
to the terms and conditions for coverage under the patient's 94
plan in effect at the time the prior authorization was issued. 95
5. The denial of the claim was due to one of the 96
following: 97
a. Another payor is responsible for payment. 98
b. The dentist or physician has already been paid for the 99
procedures identified in the claim. 100
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c. The claim was submitted fraudulently, or the prior 101
authorization was based in whole or material part on erroneous 102
information provided to the health insurer by the dentist or 103
physician, patient, or other person not related to the insurer. 104
d. The person receiving the procedure was not eligible to 105
receive the procedure on the date of service. 106
e. The services were provided during the grace period 107
established under s. 627.608 or applicable federal regulations, 108
and the dental insurer notified the dentist or physician 109
provider that the patient was in the grace period when the 110
dentist or physician provider requested eligibility or 111
enrollment verification from the dental insurer, if such request 112
was made. 113
(b) This subsection applies to all contracts : 114
1. Between a health insurer and a dentist which are 115
delivered, issued, or renewed on or after January 1, 2025. 116
2. Between a health insurer and a physician which are 117
delivered, issued, or renewed on or after January 1, 2026. 118
(c) The office has all rights and powers to enforce this 119
subsection as provided by s. 624.307. 120
(d) The commission may adopt rules to impl ement this 121
subsection. 122
Section 2. Subsections (13) and (14) of section 641.315, 123
Florida Statutes, are amended to read: 124
641.315 Provider contracts. — 125
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
(13)(a) A contract between a health maintenance 126
organization and a dentist licensed under chapter 466 or a 127
physician licensed under chapter 458 or chapter 459 for the 128
provision of services to a subscriber of the health maintenance 129
organization may not spe cify credit card payment as the only 130
acceptable method for payments from the health maintenance 131
organization to the dentist or physician. 132
(b) When a health maintenance organization employs the 133
method of claims payment to a dentist or physician through 134
electronic funds transfer, including, but not limited to, 135
virtual credit card payment, the health maintenance organization 136
shall notify the dentist or physician as provided in this 137
paragraph and obtain the dentist's or physician's consent before 138
employing the electronic funds transfer. The dentist's or 139
physician's consent described in this paragraph applies to the 140
dentist's or physician's entire practice. For the purpose of 141
this paragraph, the dentist's or physician's consent, which may 142
be given through e-mail, must bear the signature of the dentist 143
or physician. Such signature includes an electronic or digital 144
signature if the form of signature is recognized as a valid 145
signature under applicable federal law or state contract law or 146
an act that demonstrates ex press consent, including, but not 147
limited to, checking a box indicating consent. The health 148
maintenance organization or the dentist or physician may not 149
require that a dentist's or physician's consent as described in 150
HB 1231 2025
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
this paragraph be made on a patient -by-patient basis. The 151
notification provided by the health maintenance organization to 152
the dentist or physician must include all of the following: 153
1. The fees, if any, that are associated with the 154
electronic funds transfer. 155
2. The available methods of paym ent of claims by the 156
health maintenance organization, with clear instructions to the 157
dentist or physician on how to select an alternative payment 158
method. 159
(c) A health maintenance organization that pays a claim to 160
a dentist or physician through automated clearing house transfer 161
may not charge a fee solely to transmit the payment to the 162
dentist or physician unless the dentist or physician has 163
consented to the fee. 164
(d) This subsection applies to all contracts: 165
1. Between a health maintenance organization and a dentist 166
which are delivered, issued, or renewed on or after January 1, 167
2025. 168
2. Between a health maintenance organization and a 169
physician which are delivered, issued, or renewed on or after 170
January 1, 2026. 171
(e) The office has all rights and powe rs to enforce this 172
subsection as provided by s. 624.307. 173
(f) The commission may adopt rules to implement this 174
subsection. 175
HB 1231 2025
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
(14)(a) A health maintenance organization may not deny any 176
claim subsequently submitted by a dentist licensed under chapter 177
466 or a physician licensed under chapter 458 or chapter 459 for 178
procedures specifically included in a prior authorization unless 179
at least one of the following circumstances applies for each 180
procedure denied: 181
1. Benefit limitations, such as annual maximums and 182
frequency limitations not applicable at the time of the prior 183
authorization, are reached subsequent to issuance of the prior 184
authorization. 185
2. The documentation provided by the person submitting the 186
claim fails to support the claim as originally authorized. 187
3. Subsequent to the issuance of the prior authorization, 188
new procedures are provided to the patient or a change in the 189
condition of the patient occurs such that the prior authorized 190
procedure would no longer be considered medically necessary , 191
based on the prevailing standard of care. 192
4. Subsequent to the issuance of the prior authorization, 193
new procedures are provided to the patient or a change in the 194
patient's condition occurs such that the prior authorized 195
procedure would at that time hav e required disapproval pursuant 196
to the terms and conditions for coverage under the patient's 197
plan in effect at the time the prior authorization was issued. 198
5. The denial of the claim was due to one of the 199
following: 200
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a. Another payor is responsible for payment. 201
b. The dentist or physician has already been paid for the 202
procedures identified in the claim. 203
c. The claim was submitted fraudulently, or the prior 204
authorization was based in whole or material part on erroneous 205
information provided to the heal th maintenance organization by 206
the dentist or physician, patient, or other person not related 207
to the organization. 208
d. The person receiving the procedure was not eligible to 209
receive the procedure on the date of service. 210
e. The services were provided dur ing the grace period 211
established under s. 627.608 or applicable federal regulations, 212
and the dental insurer notified the dentist or physician 213
provider that the patient was in the grace period when the 214
dentist or physician provider requested eligibility or 215
enrollment verification from the dental insurer, if such request 216
was made. 217
(b) This subsection applies to all contracts : 218
1. Between a health maintenance organization and a dentist 219
which are delivered, issued, or renewed on or after January 1, 220
2025. 221
2. Between a health maintenance organization and a 222
physician which are delivered, issued, or renewed on or after 223
January 1, 2026. 224
(c) The office has all rights and powers to enforce this 225
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
subsection as provided by s. 624.307. 226
(d) The commission may adopt rules to implement this 227
subsection. 228
Section 3. This act shall take effect July 1, 2025. 229