Establishes Center for the Study of Health Care Billing Data.
Impact
The bill aims to enhance transparency in health care billing by providing a public database that details the usual charges by health care providers. This move is expected to streamline the reimbursement process for insurance carriers when dealing with out-of-network charges, as they will utilize this data to set reimbursement amounts. Additionally, the Center is expected to contribute to health policy research and development in New Jersey, fostering a better understanding of health care costs and encouraging informed decision-making among consumers and providers.
Summary
Senate Bill S1184 establishes the Center for the Study of Health Care Billing Data in New Jersey. The Center's purpose is to analyze billing data from health care providers, which insurance carriers are required to submit. This legislation mandates that carriers provide detailed billing information, including amounts billed and processed, to ensure transparency and accuracy in health care costs. The data will be analyzed to create a comprehensive database that reflects usual and customary charges for medical services in different geographic regions of the state, aiding in determining appropriate reimbursement rates for out-of-network providers.
Contention
While the bill has been largely supported for its potential to improve health care cost transparency, there may be contention surrounding the implications it could have on insurance carriers. Some may view the requirement to submit extensive data as burdensome, leading to concerns about administrative overhead costs. Furthermore, ensuring the data is secure and free from conflicts of interest will be essential, as the Center will rely on collaboration with educational institutions that meet specific criteria to avoid any bias in the data analysis.
Concerns the delivery and oversight of coverage under certain health benefits plans; establishes Health Care Patient Ombudsperson in the Division of Consumer Affairs.
An Act Concerning The Insurance Department's Market Conduct Authority And Data Call Confidentiality, Authorizing Multistate Health Care Centers In Connecticut, Eliminating A Health Carrier Utilization Review Report Filing Requirement, And Concerning Licensure Of Single Purpose Dental Health Care Centers.
Relating to the establishment of a statewide all payor claims database to increase public transparency of health care data and improve quality of health care in this state.