97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB3812
 
Introduced 10/5/2011, by Rep. Daniel J. Burke
 
SYNOPSIS AS INTRODUCED:
 

 



215 ILCS 5/368c

     Amends the Illinois Insurance Code. Provides that prior to providing care to a person, a health care professional or health care provider shall verify whether that health care professional or health care provider is in the network of participating providers whose services are covered by the person's policy of accident and health insurance and shall notify the person of this information.
  


LRB097 13098 RPM 57604 b

 
 
A BILL FOR
 

  
HB3812LRB097 13098 RPM 57604 b


  
1    AN ACT concerning insurance.
  
 
2    Be it enacted by the People of the State of Illinois,
 
3represented in the General Assembly:
  
 
 
4    Section 5. The Illinois Insurance Code is amended  by 
5changing Section 368c as follows:
 



6    (215 ILCS 5/368c)



7    Sec. 368c. Remittance advice and procedures. 

8    (a) A remittance advice shall be furnished to a health care 
9professional or
health
care provider that identifies the 
10disposition of each claim.  The remittance
advice shall identify 
11the services billed; the patient responsibility, if any;
the 
12actual payment, if any, for the services billed; and the reason 
13for any
reduction to the amount for
which the claim was 
14submitted.  For any reductions to the amount for which the
claim 
15was submitted, the remittance shall identify any withholds and 
16the reason
for any denial or reduction.

17    A remittance advice for capitation or prospective payment 
18arrangements shall
be
furnished to a health care professional 
19or health care provider pursuant to a
contract with
an insurer, 
20health maintenance organization,
independent practice 
21association,
or
physician hospital organization in accordance 
22with the terms of the contract.

23    (b) When health care services are provided by a 
 
 
HB3812- 2 -LRB097 13098 RPM 57604 b

1non-participating
health care
professional or health care 
2provider, an insurer, health maintenance
organization,

3independent practice association, or physician hospital 
4organization may pay
for covered
services either to a patient 
5directly or to the non-participating health care
professional 
6or
health care provider.

7    (c) When a person presents a
benefits information card,
a 
8health care professional or health care provider shall make a 
9good faith
effort
to inform the
person if the
health care 
10professional or health care provider has a participation 
11contract
with the
insurer,
health maintenance organization, or 
12other
entity identified on the card.

13    (d) Notwithstanding any other provision of this Section, 
14prior to providing care to a person, a health care professional 
15or health care provider shall verify whether that health care 
16professional or health care provider is in the network of 
17participating providers whose services are covered by the 
18person's policy of accident and health insurance and shall 
19notify the person of this information. 
20(Source: P.A. 93-261, eff. 1-1-04.)