Illinois 2025-2026 Regular Session

Illinois House Bill HB1864 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	HB1864 EngrossedLRB104 06097 BAB 16130 b HB1864 Engrossed LRB104 06097 BAB 16130 b
2		-	HB1864 Engrossed LRB104 06097 BAB 16130 b
	1	+	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1864 Introduced , by Rep. Robert "Bob" Rita SYNOPSIS AS INTRODUCED: 215 ILCS 111/15215 ILCS 111/20215 ILCS 111/25215 ILCS 111/30 new215 ILCS 111/35 new215 ILCS 111/40 new215 ILCS 111/45 new Amends the Uniform Electronic Transactions in Dental Care Billing Act. Provides that beginning January 1, 2028 (instead of 2026), 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. Sets forth exemptions from the requirements of the Act, and requires a dental care provider who is exempt from the requirements of the Act to file a form with the Department of Insurance indicating the applicable exemption. Requires each dental plan carrier to establish a portal that provides certain benefit and billing information. Requires a dental plan carrier to establish an electronic portal that allows dental care providers to submit claims electronically and directly to the dental care provider; accept attachments in an electronic format with the initial electronic claim's submission; and provide remittance advice with the corresponding payment. Provides that nothing in the Act requires a dental care provider to only accept electronic payment from a dental plan carrier. Provides that dental plan carriers shall allow alternative forms of payment, without additional fees or charges, to a dental care provider, if requested. Effective immediately. LRB104 06097 BAB 16130 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1864 Introduced , by Rep. Robert "Bob" Rita SYNOPSIS AS INTRODUCED: 215 ILCS 111/15215 ILCS 111/20215 ILCS 111/25215 ILCS 111/30 new215 ILCS 111/35 new215 ILCS 111/40 new215 ILCS 111/45 new 215 ILCS 111/15 215 ILCS 111/20 215 ILCS 111/25 215 ILCS 111/30 new 215 ILCS 111/35 new 215 ILCS 111/40 new 215 ILCS 111/45 new Amends the Uniform Electronic Transactions in Dental Care Billing Act. Provides that beginning January 1, 2028 (instead of 2026), 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. Sets forth exemptions from the requirements of the Act, and requires a dental care provider who is exempt from the requirements of the Act to file a form with the Department of Insurance indicating the applicable exemption. Requires each dental plan carrier to establish a portal that provides certain benefit and billing information. Requires a dental plan carrier to establish an electronic portal that allows dental care providers to submit claims electronically and directly to the dental care provider; accept attachments in an electronic format with the initial electronic claim's submission; and provide remittance advice with the corresponding payment. Provides that nothing in the Act requires a dental care provider to only accept electronic payment from a dental plan carrier. Provides that dental plan carriers shall allow alternative forms of payment, without additional fees or charges, to a dental care provider, if requested. Effective immediately. LRB104 06097 BAB 16130 b LRB104 06097 BAB 16130 b A BILL FOR
	2	+	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1864 Introduced , by Rep. Robert "Bob" Rita SYNOPSIS AS INTRODUCED:
	3	+	215 ILCS 111/15215 ILCS 111/20215 ILCS 111/25215 ILCS 111/30 new215 ILCS 111/35 new215 ILCS 111/40 new215 ILCS 111/45 new 215 ILCS 111/15 215 ILCS 111/20 215 ILCS 111/25 215 ILCS 111/30 new 215 ILCS 111/35 new 215 ILCS 111/40 new 215 ILCS 111/45 new
	4	+	215 ILCS 111/15
	5	+	215 ILCS 111/20
	6	+	215 ILCS 111/25
	7	+	215 ILCS 111/30 new
	8	+	215 ILCS 111/35 new
	9	+	215 ILCS 111/40 new
	10	+	215 ILCS 111/45 new
	11	+	Amends the Uniform Electronic Transactions in Dental Care Billing Act. Provides that beginning January 1, 2028 (instead of 2026), 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. Sets forth exemptions from the requirements of the Act, and requires a dental care provider who is exempt from the requirements of the Act to file a form with the Department of Insurance indicating the applicable exemption. Requires each dental plan carrier to establish a portal that provides certain benefit and billing information. Requires a dental plan carrier to establish an electronic portal that allows dental care providers to submit claims electronically and directly to the dental care provider; accept attachments in an electronic format with the initial electronic claim's submission; and provide remittance advice with the corresponding payment. Provides that nothing in the Act requires a dental care provider to only accept electronic payment from a dental plan carrier. Provides that dental plan carriers shall allow alternative forms of payment, without additional fees or charges, to a dental care provider, if requested. Effective immediately.
	12	+	LRB104 06097 BAB 16130 b LRB104 06097 BAB 16130 b
	13	+	LRB104 06097 BAB 16130 b
	14	+	A BILL FOR
	15	+	HB1864LRB104 06097 BAB 16130 b HB1864 LRB104 06097 BAB 16130 b
	16	+	HB1864 LRB104 06097 BAB 16130 b
3	17		1 AN ACT concerning regulation.
4	18		2 Be it enacted by the People of the State of Illinois,
5	19		3 represented in the General Assembly:
6	20		4 Section 5. The Uniform Electronic Transactions in Dental
7		-	5 Care Billing Act is amended by changing Sections 5, 15, 20, and
8		-	6 25 and by adding Sections 30, 35, and 40 as follows:
9		-	7 (215 ILCS 111/5)
10		-	8 Sec. 5. Purpose. The purpose of this Act is to standardize
11		-	9 the forms used in the billing and reimbursement of dental
12		-	10 care, reduce the number of forms used, increase efficiency in
13		-	11 the reimbursement of dental care through standardization, and
14		-	12 encourage the use of and prescribe a timetable for
15		-	13 implementation of a secure electronic data interchange of
16		-	14 dental care expenses and reimbursement.
17		-	15 (Source: P.A. 102-146, eff. 7-23-21.)
18		-	16 (215 ILCS 111/15)
19		-	17 Sec. 15. Definitions. As used in this Act:
20		-	18 "Department" means the Department of Insurance.
21		-	19 "Director" means the Director of Insurance.
22		-	20 "Dental care provider" means a dentist who bills for
23		-	21 services in Illinois.
24		-	22 "Dental plan carrier" means an entity subject to the
	21	+	5 Care Billing Act is amended by changing Sections 15, 20, and 25
	22	+	6 and by adding Sections 30, 35, 40, and 45 as follows:
	23	+	7 (215 ILCS 111/15)
	24	+	8 Sec. 15. Definitions. As used in this Act:
	25	+	9 "Department" means the Department of Insurance.
	26	+	10 "Director" means the Director of Insurance.
	27	+	11 "Dental care provider" means a dentist who bills for
	28	+	12 services in Illinois.
	29	+	13 "Dental plan carrier" means an entity subject to the
	30	+	14 insurance laws and regulations of this State or subject to the
	31	+	15 jurisdiction of the Director that contracts or offers to
	32	+	16 contract to provide, deliver, arrange for, pay for, or
	33	+	17 reimburse any of the costs of dental care services, including
	34	+	18 an accident and health insurance company, a health maintenance
	35	+	19 organization, a limited health service organization, a dental
	36	+	20 service plan corporation, a health services plan corporation,
	37	+	21 a voluntary health services plan, or any other entity
	38	+	22 providing a plan of dental insurance, dental benefits, or
	39	+	23 dental health care services.
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33		-	1 insurance laws and regulations of this State or subject to the
34		-	2 jurisdiction of the Director that contracts or offers to
35		-	3 contract to provide, deliver, arrange for, pay for, or
36		-	4 reimburse any of the costs of dental care services, including
37		-	5 an accident and health insurance company, a health maintenance
38		-	6 organization, a limited health service organization, a dental
39		-	7 service plan corporation, a health services plan corporation,
40		-	8 a voluntary health services plan, or any other entity
41		-	9 providing a plan of dental insurance, dental benefits, or
42		-	10 dental health care services.
43		-	11 "Portal" means a website or reasonably similar method of
44		-	12 sharing information that: (i) is compliant with the federal
45		-	13 Health Insurance Portability and Accountability Act of 1996
46		-	14 and the regulations promulgated thereunder, and (ii) provides
47		-	15 resources and information to dental care providers and
48		-	16 subscribers.
49		-	17 (Source: P.A. 102-146, eff. 7-23-21.)
50		-	18 (215 ILCS 111/20)
51		-	19 Sec. 20. Uniform electronic claims and eligibility
52		-	20 transactions required.
53		-	21 (a) Beginning January 1, 2027 2026, no dental plan carrier
54		-	22 is required to accept from a dental care provider eligibility
55		-	23 for a dental plan transaction or dental care claims or
56		-	24 equivalent encounter information transaction except as
57		-	25 provided in this Act.
	43	+	104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 HB1864 Introduced , by Rep. Robert "Bob" Rita SYNOPSIS AS INTRODUCED:
	44	+	215 ILCS 111/15215 ILCS 111/20215 ILCS 111/25215 ILCS 111/30 new215 ILCS 111/35 new215 ILCS 111/40 new215 ILCS 111/45 new 215 ILCS 111/15 215 ILCS 111/20 215 ILCS 111/25 215 ILCS 111/30 new 215 ILCS 111/35 new 215 ILCS 111/40 new 215 ILCS 111/45 new
	45	+	215 ILCS 111/15
	46	+	215 ILCS 111/20
	47	+	215 ILCS 111/25
	48	+	215 ILCS 111/30 new
	49	+	215 ILCS 111/35 new
	50	+	215 ILCS 111/40 new
	51	+	215 ILCS 111/45 new
	52	+	Amends the Uniform Electronic Transactions in Dental Care Billing Act. Provides that beginning January 1, 2028 (instead of 2026), 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. Sets forth exemptions from the requirements of the Act, and requires a dental care provider who is exempt from the requirements of the Act to file a form with the Department of Insurance indicating the applicable exemption. Requires each dental plan carrier to establish a portal that provides certain benefit and billing information. Requires a dental plan carrier to establish an electronic portal that allows dental care providers to submit claims electronically and directly to the dental care provider; accept attachments in an electronic format with the initial electronic claim's submission; and provide remittance advice with the corresponding payment. Provides that nothing in the Act requires a dental care provider to only accept electronic payment from a dental plan carrier. Provides that dental plan carriers shall allow alternative forms of payment, without additional fees or charges, to a dental care provider, if requested. Effective immediately.
	53	+	LRB104 06097 BAB 16130 b LRB104 06097 BAB 16130 b
	54	+	LRB104 06097 BAB 16130 b
	55	+	A BILL FOR
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	61	+	215 ILCS 111/15
	62	+	215 ILCS 111/20
	63	+	215 ILCS 111/25
	64	+	215 ILCS 111/30 new
	65	+	215 ILCS 111/35 new
	66	+	215 ILCS 111/40 new
	67	+	215 ILCS 111/45 new
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68		-	1 (b) All dental plan carriers and dental care providers
69		-	2 must exchange claims and eligibility information
70		-	3 electronically using the standard electronic data interchange
71		-	4 transactions for claims submissions, payments, and
72		-	5 verification of benefits required under the Health Insurance
73		-	6 Portability and Accountability Act in order to be compensable
74		-	7 by the dental plan carrier.
75		-	8 (c) All dental plan carriers and dental care providers
76		-	9 must comply with applicable State and federal privacy and
77		-	10 security laws, and regulations when conducting the exchange of
78		-	11 information under this Act.
79		-	12 (Source: P.A. 102-146, eff. 7-23-21; 103-705, eff. 7-19-24.)
80		-	13 (215 ILCS 111/25)
81		-	14 Sec. 25. Rules; modification of rules.
82		-	15 (a) The Department may shall adopt rules as necessary to
83		-	16 implement this Act and may establish further exemptions to
84		-	17 this Act by rule.
85		-	18 (b) A dental plan carrier or dental care provider may not
86		-	19 add to or modify the uniform electronic claims and eligibility
87		-	20 requirements adopted by the Department.
88		-	21 (Source: P.A. 102-146, eff. 7-23-21.)
89		-	22 (215 ILCS 111/30 new)
90		-	23 Sec. 30. Exemptions.
91		-	24 (a) Notwithstanding any other provision of this Act, a
	70	+
	71	+	LRB104 06097 BAB 16130 b
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102		-	1 dental care provider shall not be required to submit claims
103		-	2 electronically under any of the following circumstances:
104		-	3 (1) There is a temporary technological event, due to
105		-	4 unforeseen practice disruptions, including, but not
106		-	5 limited to, natural disasters, physical damage to the
107		-	6 practice, or damage to the data system that prevents a
108		-	7 claim from being submitted electronically for more than 14
109		-	8 days.
110		-	9 (2) The dental care provider plans to retire prior to
111		-	10 January 1, 2031.
112		-	11 (3) A dental care provider works less than 20 hours
113		-	12 per week and is a solo practitioner.
114		-	13 (4) The dental care provider is a dental care provider
115		-	14 who is temporarily operating a practice for another dental
116		-	15 care provider who is unable to practice.
117		-	16 (b) A dental care provider who is exempted from filing
118		-	17 claims electronically under this Section shall file a form
119		-	18 with the Department indicating the applicable exemption. The
120		-	19 Department shall provide the form no later than January 1,
121		-	20 2027.
122		-	21 (c) Any dental care provider that starts a dental care
123		-	22 practice or purchases a practice and who was previously
124		-	23 exempted from the requirements of this Act shall have 2 years
125		-	24 from the date the practice is started or purchased to comply
126		-	25 with this Act.
	79	+
	80	+
	81	+	HB1864 LRB104 06097 BAB 16130 b
	82	+
	83	+
	84	+	HB1864- 2 -LRB104 06097 BAB 16130 b HB1864 - 2 - LRB104 06097 BAB 16130 b
	85	+	HB1864 - 2 - LRB104 06097 BAB 16130 b
	86	+	1 "Portal" means a website or reasonably similar method of
	87	+	2 sharing information that (i) is compliant with the federal
	88	+	3 Health Insurance Portability and Accountability Act of 1996
	89	+	4 and the regulations promulgated thereunder, (ii) provides
	90	+	5 resources and information to dentists and subscribers, and
	91	+	6 (iii) is compatible with dental software so universal
	92	+	7 accessibility may be achieved.
	93	+	8 (Source: P.A. 102-146, eff. 7-23-21.)
	94	+	9 (215 ILCS 111/20)
	95	+	10 Sec. 20. Uniform electronic claims and eligibility
	96	+	11 transactions required.
	97	+	12 (a) Beginning January 1, 2028 2026, no dental plan carrier
	98	+	13 is required to accept from a dental care provider eligibility
	99	+	14 for a dental plan transaction or dental care claims or
	100	+	15 equivalent encounter information transaction except as
	101	+	16 provided in this Act.
	102	+	17 (b) All dental plan carriers and dental care providers
	103	+	18 must exchange claims and eligibility information
	104	+	19 electronically using the standard electronic data interchange
	105	+	20 transactions for claims submissions, payments, and
	106	+	21 verification of benefits required under the Health Insurance
	107	+	22 Portability and Accountability Act in order to be compensable
	108	+	23 by the dental plan carrier.
	109	+	24 (Source: P.A. 102-146, eff. 7-23-21; 103-705, eff. 7-19-24.)
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	115	+	HB1864 - 2 - LRB104 06097 BAB 16130 b
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137		-	1 (215 ILCS 111/35 new)
138		-	2 Sec. 35. Eligibility and benefit verification portal.
139		-	3 (a) Each dental plan carrier shall establish a portal as
140		-	4 described in this Section and shall include information about
141		-	5 each type of subscription contract that is sufficient to allow
142		-	6 subscribers and dental care providers to determine the covered
143		-	7 services under each subscription contract and the payment or
144		-	8 reimbursement amounts for those covered services at the
145		-	9 procedure level. The information in the portal shall include
146		-	10 the following, as appropriate:
147		-	11 (1) Effective date of plan.
148		-	12 (2) Termination date of plan.
149		-	13 (3) Coordination of benefits; standard or
150		-	14 non-duplicating.
151		-	15 (4) Claim address.
152		-	16 (5) Payer identification.
153		-	17 (6) Covered services.
154		-	18 (7) Whether a deductible applies and to which
155		-	19 services.
156		-	20 (8) Remaining deductible: family.
157		-	21 (9) Remaining deductible: individual.
158		-	22 (10) In-network coinsurance percentage.
159		-	23 (11) Out-of-network coinsurance percentage.
160		-	24 (12) Remaining plan maximum.
161		-	25 (13) Remaining lifetime maximum, if applicable.
162		-	26 (14) Previous 12 months of claim payments applied to
	118	+	HB1864- 3 -LRB104 06097 BAB 16130 b HB1864 - 3 - LRB104 06097 BAB 16130 b
	119	+	HB1864 - 3 - LRB104 06097 BAB 16130 b
	120	+	1 (215 ILCS 111/25)
	121	+	2 Sec. 25. Rules; modification of rules.
	122	+	3 (a) The Department may shall adopt rules as necessary to
	123	+	4 implement this Act and may establish further exemptions to
	124	+	5 this Act by rule.
	125	+	6 (b) A dental plan carrier or dental care provider may not
	126	+	7 add to or modify the uniform electronic claims and eligibility
	127	+	8 requirements adopted by the Department.
	128	+	9 (Source: P.A. 102-146, eff. 7-23-21.)
	129	+	10 (215 ILCS 111/30 new)
	130	+	11 Sec. 30. Exemptions. Notwithstanding any other provision
	131	+	12 of this Act, a dental care provider shall not be required to
	132	+	13 submit claims electronically under any of the following
	133	+	14 circumstances:
	134	+	15 (1) The dental care provider is with a dental practice
	135	+	16 that, including the dental care provider, employs 4 or
	136	+	17 fewer full-time or full-time equivalent employees.
	137	+	18 (2) There is a temporary technological or electrical
	138	+	19 failure that prevents a claim from being submitted
	139	+	20 electronically.
	140	+	21 (3) The dental care provider graduated from a dental
	141	+	22 school in 1985 or before.
	142	+	23 (4) The dental care provider graduated from a dental
	143	+	24 school within 10 years before the effective date of this
	144	+	25 amendatory Act of the 104th General Assembly and meets one
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	150	+	HB1864 - 3 - LRB104 06097 BAB 16130 b
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173		-	1 the member's annual maximum or deductible to help
174		-	2 determine if a benefit has been used outside of the
175		-	3 primary office.
176		-	4 (15) Age limitation.
177		-	5 (16) Frequency limit by time period.
178		-	6 (17) Frequency limit by tooth number.
179		-	7 (18) Next available service date or previous service
180		-	8 dates based on any frequency limit due to prior treatment
181		-	9 history or added custom benefits, such as medical
182		-	10 conditions and roll-over.
183		-	11 (19) Number of quads benefited per visit if a specific
184		-	12 benefit limitation exists that may limit the number of
185		-	13 quads treated and services rendered per visit.
186		-	14 (20) Waiting period due to preexisting condition or
187		-	15 missing tooth limitation.
188		-	16 (21) Prior authorization requirements.
189		-	17 (22) A comprehensive list (or procedure code level
190		-	18 lookup tool) of all current American Dental Association
191		-	19 CDT Codes stating if they are covered, the percentage of
192		-	20 coverage, and if there are any conditions that preclude
193		-	21 coverage.
194		-	22 (b) At minimum, the portal shall provide current and
195		-	23 accurate real-time benefit eligibility and benefits
196		-	24 information. It is the responsibility of the dental plan
197		-	25 carrier to ensure patient eligibility and benefits reporting
198		-	26 is timely and accurate.
	153	+	HB1864- 4 -LRB104 06097 BAB 16130 b HB1864 - 4 - LRB104 06097 BAB 16130 b
	154	+	HB1864 - 4 - LRB104 06097 BAB 16130 b
	155	+	1 of the following criteria:
	156	+	2 (A) The dental care provider started his or her
	157	+	3 own practice.
	158	+	4 (B) The dental care provider has purchased a
	159	+	5 practice that has been previously exempted from the
	160	+	6 requirements of this Act.
	161	+	7 (5) The dental care provider demonstrates financial
	162	+	8 difficulties in buying or managing an electronic claims
	163	+	9 submission software system.
	164	+	10 (6) The dental care provider has a disability or
	165	+	11 medical reason that prohibits the dental care provider
	166	+	12 from submitting claims electronically.
	167	+	13 (7) The dental care provider is a temporary dentist
	168	+	14 operating a practice for another dentist who is
	169	+	15 temporarily unable to practice.
	170	+	16 (8) There are other unforeseen practice disruptions,
	171	+	17 including, but not limited to, natural disasters, physical
	172	+	18 damage to the practice, or damage to the data system.
	173	+	19 A dental care provider who is exempted from filing claims
	174	+	20 electronically under this Section shall file a form with the
	175	+	21 Department indicating the applicable exemption. The Department
	176	+	22 shall provide the form no later than January 1, 2028.
	177	+	23 (215 ILCS 111/35 new)
	178	+	24 Sec. 35. Eligibility and benefit verification portal.
	179	+	25 (a) Each dental plan carrier shall establish a portal as
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209		-	1 (c) A dental plan carrier must ensure that the portal:
210		-	2 (1) is compliant with the federal Health Insurance
211		-	3 Portability and Accountability Act of 1996 and the
212		-	4 regulations promulgated thereunder and allows dental care
213		-	5 providers to submit claims electronically and directly to
214		-	6 the dental plan carrier. The portal shall be provided free
215		-	7 of charge to the dental care provider;
216		-	8 (2) accepts attachments, including, but not limited
217		-	9 to, x-rays and other supporting information for claims, in
218		-	10 an electronic format with the initial electronic claim's
219		-	11 submission and any further submissions thereafter; and
220		-	12 (3) offers remittance advice with the corresponding
221		-	13 payment that outlines individually per claim: the name of
222		-	14 the patient; the date of service; the service code or, if
223		-	15 no service code is available, a service description; the
224		-	16 amount being paid; the claim number; and other identifying
225		-	17 claim information found on an explanation of benefits
226		-	18 form.
227		-	19 (215 ILCS 111/40 new)
228		-	20 Sec. 40. Payment. Nothing in this Act requires a dental
229		-	21 care provider to only accept electronic payment from a dental
230		-	22 plan carrier.
231		-	23 Section 99. Effective date. This Act takes effect upon
232		-	24 becoming law, except that Sections 30, 35, and 40 of the
233		-	25 Uniform Electronic Transactions in Dental Care Billing Act
	188	+	HB1864- 5 -LRB104 06097 BAB 16130 b HB1864 - 5 - LRB104 06097 BAB 16130 b
	189	+	HB1864 - 5 - LRB104 06097 BAB 16130 b
	190	+	1 described in this Section and shall include information about
	191	+	2 each type of subscription contract that is sufficient to allow
	192	+	3 subscribers and dentists to determine the covered services
	193	+	4 under each subscription contract and the payment or
	194	+	5 reimbursement amounts for those covered services at the
	195	+	6 procedure level. The information in the portal shall include
	196	+	7 the following, as appropriate:
	197	+	8 (1) Effective date of plan.
	198	+	9 (2) Status of plan.
	199	+	10 (3) Termination date of plan.
	200	+	11 (4) Coordination of benefits; standard or
	201	+	12 non-duplicating.
	202	+	13 (5) Claim address.
	203	+	14 (6) Payer identification.
	204	+	15 (7) Covered services.
	205	+	16 (8) Whether a deductible applies and to which
	206	+	17 services.
	207	+	18 (9) Remaining deductible: family.
	208	+	19 (10) Remaining deductible: individual.
	209	+	20 (11) Preferred in-network co-insurance amount.
	210	+	21 (12) In-network co-insurance amount.
	211	+	22 (13) Out-of-network co-insurance amount.
	212	+	23 (14) Preferred in-network co-payment amount.
	213	+	24 (15) In-network co-payment amount.
	214	+	25 (16) Out-of-network co-payment amount.
	215	+	26 (17) Remaining plan maximum.
234	216
235	217
236	218
237	219
238	220
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	221	+	HB1864 - 5 - LRB104 06097 BAB 16130 b
240	222
241	223
242		-	HB1864 Engrossed- 8 -LRB104 06097 BAB 16130 b HB1864 Engrossed - 8 - LRB104 06097 BAB 16130 b
243		-	HB1864 Engrossed - 8 - LRB104 06097 BAB 16130 b
244		-	1 take effect January 1, 2027.
	224	+	HB1864- 6 -LRB104 06097 BAB 16130 b HB1864 - 6 - LRB104 06097 BAB 16130 b
	225	+	HB1864 - 6 - LRB104 06097 BAB 16130 b
	226	+	1 (18) Remaining lifetime maximum.
	227	+	2 (19) Last treatment plan payment date applied to the
	228	+	3 annual maximum or deductible to help determine if a
	229	+	4 benefit has been used outside of the primary office.
	230	+	5 (20) Age limitation.
	231	+	6 (21) Frequency limit by time period.
	232	+	7 (22) Frequency limit by tooth number.
	233	+	8 (23) Next available service date based on any
	234	+	9 frequency limit due to prior treatment history or added
	235	+	10 custom benefits, such as medical conditions and roll-over.
	236	+	11 (24) Whether there is a missing tooth clause.
	237	+	12 (25) Number of quads benefited per visit.
	238	+	13 (26) Waiting period due to preexisting condition or
	239	+	14 missing tooth limitation.
	240	+	15 (27) Prior authorization requirements.
	241	+	16 (28) Processing policies, such as bundling,
	242	+	17 downcoding, least expensive alternative treatment
	243	+	18 requirements, fees disallowed in conjunction with other
	244	+	19 treatments, and limitations by location.
	245	+	20 (29) A comprehensive list of all current American
	246	+	21 Dental Association Codes stating if they are covered, the
	247	+	22 percentage of coverage, and if there are any conditions
	248	+	23 that preclude coverage.
	249	+	24 (b) At minimum, the portal shall provide current and
	250	+	25 accurate real-time benefit eligibility and benefits
	251	+	26 information. It is the responsibility of the dental plan
245	252
246	253
247	254
248	255
249	256
250		-	HB1864 Engrossed - 8 - LRB104 06097 BAB 16130 b
	257	+	HB1864 - 6 - LRB104 06097 BAB 16130 b
	258	+
	259	+
	260	+	HB1864- 7 -LRB104 06097 BAB 16130 b HB1864 - 7 - LRB104 06097 BAB 16130 b
	261	+	HB1864 - 7 - LRB104 06097 BAB 16130 b
	262	+	1 carrier to ensure patient eligibility and benefits reporting
	263	+	2 is timely and accurate.
	264	+	3 (215 ILCS 111/40 new)
	265	+	4 Sec. 40. Dental plan carrier requirements. A dental plan
	266	+	5 carrier must:
	267	+	6 (1) Provide an electronic portal that is compliant
	268	+	7 with the federal Health Insurance Portability and
	269	+	8 Accountability Act of 1996 and the regulations promulgated
	270	+	9 thereunder and that allows dental care providers to submit
	271	+	10 claims electronically and directly to dental plan carrier.
	272	+	11 The portal shall be provided free of charge to the dental
	273	+	12 care provider.
	274	+	13 (2) Accept attachments, including, but not limited to,
	275	+	14 x-rays and other supporting information for claims, in an
	276	+	15 electronic format with the initial electronic claim's
	277	+	16 submission and any further submissions thereafter.
	278	+	17 (3) Provide remittance advice with the corresponding
	279	+	18 payment that outlines individually per claim: the name of
	280	+	19 the patient; the date of service; the service code or, if
	281	+	20 no service code is available, a service description; the
	282	+	21 amount being paid; the claim number; and other identifying
	283	+	22 claim information found on an explanation of benefits
	284	+	23 form.
	285	+	24 (215 ILCS 111/45 new)
	286	+
	287	+
	288	+
	289	+
	290	+
	291	+	HB1864 - 7 - LRB104 06097 BAB 16130 b
	292	+
	293	+
	294	+	HB1864- 8 -LRB104 06097 BAB 16130 b HB1864 - 8 - LRB104 06097 BAB 16130 b
	295	+	HB1864 - 8 - LRB104 06097 BAB 16130 b
	296	+	1 Sec. 45. Payment. Nothing in this Act requires a dental
	297	+	2 care provider to only accept electronic payment from a dental
	298	+	3 plan carrier. Dental plan carriers shall allow alternative
	299	+	4 forms of payment, without additional fees or charges, to a
	300	+	5 dental care provider, if requested.
	301	+
	302	+
	303	+
	304	+
	305	+
	306	+	HB1864 - 8 - LRB104 06097 BAB 16130 b