Sen. Dave Syverson
Filed: 3/16/2020
 
 

 

 

 
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1
AMENDMENT TO SENATE BILL 3120 




2    AMENDMENT NO. ______. Amend Senate Bill 3120 by replacing 
3everything after the enacting clause with the following:

 
4    "Section 1. Short title. This Act may be cited as the 
5Uniform Electronic Transactions in Dental Care Billing 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.
 
 
 
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1    Section 15. Definitions.  As used in this Act:

2    "Department" means the Department of Insurance.

3    "Director" means the Director of Insurance.

4    "Dental care provider" means a dentist who bills for 
5services in Illinois.

6    "Dental plan carrier" means an entity subject to the 
7insurance laws and regulations of this State or subject to the 
8jurisdiction of the Director that contracts or offers to 
9contract to provide, deliver, arrange for, pay for, or 
10reimburse any of the costs of dental care services, including 
11an accident and health insurance company, a health maintenance 
12organization, a limited health service organization, a dental 
13service plan corporation, a health services plan corporation, a 
14voluntary health services plan, or any other entity providing a 
15plan of dental insurance, dental benefits, or dental health 
16care services. "Dental plan carrier" includes employee or 
17employer self-insured benefit plans under the federal Employee 
18Retirement Income Security Act of 1974.

 
19    Section 20. Uniform electronic claims and eligibility 
20transactions required.
 
21    (a)   Beginning January 1, 2025, no dental plan carrier is 
22required to accept from a dental care provider eligibility for 
23a dental plan transaction or dental care claims or equivalent 
24encounter information transaction except as provided in this 
 
 
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1Act.

2    (b)   All dental plan carriers and dental care providers must 
3exchange claims and eligibility information electronically 
4using the standard electronic data interchange transactions 
5for claims submissions, payments, and verification of benefits 
6required under the Health Insurance Portability and 
7Accountability Act in order to be compensable by the dental 
8plan carrier.

 
9    Section 25. Rules; modification of rules.
 
10    (a)   The Department shall adopt rules as necessary to 
11implement this Act and may establish exemptions to this Act by 
12regulation.

13    (b)   A dental plan carrier or dental care provider may not 
14add to or modify the uniform electronic claims and eligibility 
15requirements adopted by the Department.

 
16    Section 30. Compliance and investigations.  The Director 
17has the right to investigate complaints filed under this Act. 
18Complaints filed under this Section must:

19        (1) be filed in writing, either on paper or 
20    electronically;

21        (2) name the person that is the subject of the 
22    complaint and describe the acts or omissions believed to be 
23    in violation of this Act; and

24        (3) be filed within 180 days after the complainant knew 
 
 
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1    or should have known that the act or omission complained of 
2    occurred.

3    The Director may prescribe additional procedures for the 
4filing of complaints as required to satisfy the requirements of 
5this Section.


 
6    Section 99. Effective date. This Act takes effect upon 
7becoming law.".