Bill Text: IL HB5107 | 2009-2010 | 96th General Assembly | Introduced
Bill Title: Amends the Illinois Insurance Code. In the provision concerning recoupment, provides that no recoupment or offset may be requested or withheld from future payments 180 or more days after the original payment is made. Provides that no contract between an insurer and a health care professional or health care provider may provide for recoupments in violation of the provision concerning recoupment.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2010-03-26 - Rule 19(a) / Re-referred to Rules Committee [HB5107 Detail]
Download: Illinois-2009-HB5107-Introduced.html
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1 | AN ACT concerning insurance.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Insurance Code is amended by | |||||||||||||||||||
5 | changing Section 368d as follows:
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6 | (215 ILCS 5/368d)
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7 | Sec. 368d. Recoupments.
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8 | (a) A health care professional or health care provider | |||||||||||||||||||
9 | shall be provided a
remittance advice, which must include an | |||||||||||||||||||
10 | explanation of a
recoupment or
offset taken by an insurer, | |||||||||||||||||||
11 | health maintenance organization,
independent practice | |||||||||||||||||||
12 | association, or physician hospital
organization, if any. The | |||||||||||||||||||
13 | recoupment explanation shall, at a minimum, include
the name
of | |||||||||||||||||||
14 | the patient; the date of service; the service code or if no | |||||||||||||||||||
15 | service code is
available a service description;
the recoupment | |||||||||||||||||||
16 | amount; and the reason for the recoupment or offset. In
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17 | addition,
an insurer,
health maintenance organization, | |||||||||||||||||||
18 | independent
practice association, or physician
hospital | |||||||||||||||||||
19 | organization shall provide with the remittance advice a | |||||||||||||||||||
20 | telephone
number or mailing address to initiate an appeal of | |||||||||||||||||||
21 | the recoupment or offset.
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22 | (b) It is not a recoupment when a health care professional | |||||||||||||||||||
23 | or health care
provider
is paid an amount prospectively or |
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1 | concurrently under a contract with an
insurer, health
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2 | maintenance organization, independent practice
association, or | ||||||
3 | physician
hospital
organization that requires a retrospective | ||||||
4 | reconciliation based upon specific
conditions
outlined in the | ||||||
5 | contract. | ||||||
6 | (c) No recoupment or offset may be requested or withheld | ||||||
7 | from future payments 180 or more days after the original | ||||||
8 | payment is made. No contract between an insurer and a health | ||||||
9 | care professional or health care provider may provide for | ||||||
10 | recoupments in violation of this Section.
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11 | (Source: P.A. 93-261, eff. 1-1-04.)
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