Bill Text: IL SB3120 | 2019-2020 | 101st General Assembly | Introduced

---

Bill Title: Creates the Uniform Electronic Transactions in Health Care Billing Act. Requires all health plan carriers and health care providers to exchange claims and eligibility information electronically using the companion guides, implementation guides, timelines, and standard electronic data interchange transactions for claims submissions, payments, and verification of benefits required under the Health Insurance Portability and Accountability Act in order to be compensable by the health plan carrier. Provides that no health plan carrier or health care provider may add to or modify the uniform companion guides. Provides that the Act applies to all health plan carriers. Grants the Director of Insurance the right to investigate complaints filed under the Act. Sets forth criteria for complaints filed under the Act. Requires the Department of Insurance to adopt rules, and allows the Department to establish exemptions to the Act by regulation. Defines terms. Effective immediately.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2021-01-13 - Session Sine Die [SB3120 Detail]

Download: Illinois-2019-SB3120-Introduced.html

---

101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 SB3120 Introduced 2/5/2020, by Sen. Dave Syverson SYNOPSIS AS INTRODUCED:
New Act
Creates the Uniform Electronic Transactions in Health Care Billing Act. Requires all health plan carriers and health care providers to exchange claims and eligibility information electronically using the companion guides, implementation guides, timelines, and standard electronic data interchange transactions for claims submissions, payments, and verification of benefits required under the Health Insurance Portability and Accountability Act in order to be compensable by the health plan carrier. Provides that no health plan carrier or health care provider may add to or modify the uniform companion guides. Provides that the Act applies to all health plan carriers. Grants the Director of Insurance the right to investigate complaints filed under the Act. Sets forth criteria for complaints filed under the Act. Requires the Department of Insurance to adopt rules, and allows the Department to establish exemptions to the Act by regulation. Defines terms. Effective immediately.
LRB101 19599 BMS 69075 b
A BILL FOR
SB3120 LRB101 19599 BMS 69075 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. Short title. This Act may be cited as the
Uniform Electronic Transactions in Health Care Billing Act.
Section 5. Purpose. The purpose of this Act is to
standardize the forms used in the billing and reimbursement of
health care, reduce the number of forms used, increase
efficiency in the reimbursement of health care through
standardization, and encourage the use of and prescribe a
timetable for implementation of electronic data interchange of
health care expenses and reimbursement.
Section 10. Applicability. Except as may be otherwise
specifically provided, this Act applies to all health plan
carriers.
Section 15. Definitions. As used in this Act:
"Department" means the Department of Insurance.
"Director" means the Director of Insurance.
"Health care provider" means a physician, a dentist, or any
other licensed health care provider who bills for services in
Illinois.

SB3120 - 2 - LRB101 19599 BMS 69075 b
"Health plan carrier" means an entity subject to the
insurance laws and regulations of this State or subject to the
jurisdiction of the Director that contracts or offers to
contract to provide, deliver, arrange for, pay for, or
reimburse any of the costs of health care services, including
an accident and health insurance company, a health maintenance
organization, a limited health service organization, a dental
service plan corporation, a health services plan corporation,
or any other entity providing a plan of health insurance,
dental benefits, or dental health care services. "Health plan
carrier" includes employee or employer self-insured benefit
plans under the federal Employee Retirement Income Security Act
of 1974.
Section 20. Uniform electronic claims and eligibility
transactions required.
(a) Beginning January 1, 2025, no health plan carrier is
required to accept from a health care provider eligibility for
a health plan transaction or health care claims or equivalent
encounter information transaction except as provided in this
Act.
(b) All health plan carriers and health care providers must
exchange claims and eligibility information electronically
using the companion guides, implementation guides, timelines,
and standard electronic data interchange transactions for
claims submissions, payments, and verification of benefits

SB3120 - 3 - LRB101 19599 BMS 69075 b
required under the Health Insurance Portability and
Accountability Act in order to be compensable by the health
plan carrier.
Section 25. Rules; modification of guides.
(a) The Department shall adopt rules as necessary to
implement this Act and may establish exemptions to this Act by
regulation.
(b) A health plan carrier or health care provider may not
add to or modify the uniform companion guides adopted by the
Department.
Section 30. Compliance and investigations. The Director
has the right to investigate complaints filed under this Act.
Complaints filed under this Section must:
(1) be filed in writing, either on paper or
electronically;
(2) name the person that is the subject of the
complaint and describe the acts or omissions believed to be
in violation of this Act; and
(3) be filed within 180 days after the complainant knew
or should have known that the act or omission complained of
occurred.
The Director may prescribe additional procedures for the
filing of complaints as required to satisfy the requirements of
this Section.

SB3120 - 4 - LRB101 19599 BMS 69075 b
Section 99. Effective date. This Act takes effect upon
becoming law.