101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB3323

 

Introduced , by Rep. Kambium Buckner

 

SYNOPSIS AS INTRODUCED:
 
New Act

    Creates the Uniform Dental Electronic Transactions Act. Provides that the Act applies to all dental plan carriers. Requires all dental plan carriers and dental care providers to exchange claims and eligibility information electronically using the transactions, companion guides, implementation guides, and timelines required under the Act in order to be compensable by the dental plan carrier. Provides that no dental plan carrier or provider may add to or modify the uniform companion guides. Grants the Director of Insurance the right to investigate complaints filed under the Act. Provides the required specifications of any complaint filed. Provides that the Director may impose a civil monetary penalty if the Director determines that there has been a violation of the Act. Requires the Department of Insurance to adopt rules. Defines terms. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Short title. This Act may be cited as the
5Uniform Dental Electronic Transactions Act.
 
6    Section 5. Purpose. The purpose of this Act is to
7standardize the forms used in the billing and reimbursement of
8dental care, reduce the number of forms used, increase
9efficiency in the reimbursement of dental care through
10standardization, and encourage the use of and prescribe a
11timetable for implementation of electronic data interchange of
12dental care expenses and reimbursement.
 
13    Section 10. Applicability. Except as may be otherwise
14specifically provided, this Act applies to all dental plan
15carriers.
 
16    Section 15. Definitions. As used in this Act:
17    "Dental care provider" means either a general dentist or a
18dentist who is a licensed specialist.
19    "Dental plan carrier" means an entity subject to the
20insurance laws and regulations of this State or subject to the
21jurisdiction of the Director that contracts or offers to

 

 

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1contract to provide, deliver, arrange for, pay for, or
2reimburse any of the costs of dental care services, including
3an accident and health insurance company, a health maintenance
4organization, or any other entity providing a plan of dental
5insurance, dental benefits, or dental health care services.
6    "Dental plan carrier" includes limited health service
7organizations, dental service plans, and voluntary health
8service plans.
9    "Dental plan carrier" does not include employee or employer
10self-insured dental benefit plans under the federal Employee
11Retirement Income Security Act of 1974.
12    "Dentist" means a person licensed to practice dentistry in
13any state.
14    "Department" means the Department of Insurance.
15    "Director" means the Director of Insurance.
 
16    Section 20. Uniform electronic claims and eligibility
17transactions required.
18    (a) Beginning January 1, 2020, no dental plan carrier is
19required to accept from a dental care provider eligibility for
20a dental plan transaction or dental care claims or equivalent
21encounter information transaction except as provided in this
22Act.
23    (b) Beginning January 1, 2020, all dental plan carriers
24shall accept from dental care providers eligibility for a
25dental plan transaction described under the Code of Federal

 

 

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1Regulations, title 45, part 162, subpart L and the dental care
2claims or equivalent encounter information transaction
3described under the Code of Federal Regulations, title 45, part
4162, subpart K.
5    (c) Beginning January 1, 2020, all dental plan carriers
6shall transmit to dental care providers the eligibility for a
7dental plan as set forth in the Code of Federal Regulations,
8title 45, part 162, subpart L and the dental care payment and
9remittance advice transaction set forth in the Code of Federal
10Regulations, title 45, part 162, subpart P.
11    (d) All dental plan carriers and dental care providers must
12exchange claims and eligibility information electronically
13using the transactions, companion guides, implementation
14guides, and timelines required under this Act in order to be
15compensable by the dental plan carrier.
16    (e) Each of the transactions described in subsection (a)
17through (d) shall require the use of a single, uniform
18companion guide to the implementation guides described in the
19Code of Federal Regulations, title 45, part 162.
 
20    Section 25. Establishing uniform, standard companion
21guides.
22    (a) The Department shall adopt rules as necessary to
23implement this Act, including the use of the uniform, standard
24companion guides required under subsection (e) of Section 20.
25    (b) A dental plan carrier or dental care provider may not

 

 

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1add to or modify the uniform companion guides.
2    (c) In adopting the rules under this Section, the
3Department shall not require data content that is not essential
4to accomplish the purpose of the transactions in Section 20.
 
5    Section 30. Compliance and investigations. The Director
6has the right to investigate complaints filed under this Act.
7    Complaints filed under this Section must:
8        (1) be filed in writing, either on paper or
9    electronically;
10        (2) name the person that is the subject of the
11    complaint and describe the acts or omissions believed to be
12    in violation of this Act; and
13        (3) be filed within 180 days after the complainant knew
14    or should have known that the act or omission complained of
15    occurred.
16    The Director may prescribe additional procedures for the
17filing of complaints as required to satisfy the requirements of
18this Section.
19    The Director may impose a civil monetary penalty if the
20Director determines that there has been a violation of this
21Act.
 
22    Section 99. Effective date. This Act takes effect upon
23becoming law.