Bill Text: IL SB3721 | 2023-2024 | 103rd General Assembly | Introduced

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Bill Title: Amends the Uniform Electronic Transactions in Dental Care Billing Act. Provides that beginning January 1, 2027 (instead of 2025), no dental plan carrier is required to accept from a dental care provider eligibility for a dental plan transaction or dental care claims or equivalent encounter information transaction. Sets forth exemptions from the requirements of the Act, and requires a dental care provider who is exempt from the requirements of the Act to file a form with the Department of Insurance indicating the applicable exemption. Requires each dental plan carrier to establish a portal that provides certain benefit and billing information. Requires a dental plan carrier to establish an electronic portal that allows dental care providers to submit claims electronically and directly to the dental care provider; accept attachments in an electronic format with the initial electronic claim's submission; and provide remittance advice with the corresponding payment. Provides that nothing in the Act requires a dental care provider to only accept electronic payment from a dental plan carrier. Provides that dental plan carriers shall allow alternative forms of payment, without additional fees or charges, to a dental care provider, if requested. Effective immediately.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced) 2024-02-09 - Referred to Assignments [SB3721 Detail]

Download: Illinois-2023-SB3721-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB3721 Introduced 2/9/2024, by Sen. Dave Syverson SYNOPSIS AS INTRODUCED:
215 ILCS 111/15
215 ILCS 111/20
215 ILCS 111/25
215 ILCS 111/30 new
215 ILCS 111/35 new
215 ILCS 111/40 new
215 ILCS 111/45 new
Amends the Uniform Electronic Transactions in Dental Care Billing Act. Provides that beginning January 1, 2027 (instead of 2025), no dental plan carrier is required to accept from a dental care provider eligibility for a dental plan transaction or dental care claims or equivalent encounter information transaction. Sets forth exemptions from the requirements of the Act, and requires a dental care provider who is exempt from the requirements of the Act to file a form with the Department of Insurance indicating the applicable exemption. Requires each dental plan carrier to establish a portal that provides certain benefit and billing information. Requires a dental plan carrier to establish an electronic portal that allows dental care providers to submit claims electronically and directly to the dental care provider; accept attachments in an electronic format with the initial electronic claim's submission; and provide remittance advice with the corresponding payment. Provides that nothing in the Act requires a dental care provider to only accept electronic payment from a dental plan carrier. Provides that dental plan carriers shall allow alternative forms of payment, without additional fees or charges, to a dental care provider, if requested. Effective immediately.
LRB103 38525 RPS 68661 b
A BILL FOR
SB3721 LRB103 38525 RPS 68661 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Uniform Electronic Transactions in Dental
Care Billing Act is amended by changing Sections 15, 20, and 25
and by adding Sections 30, 35, 40, and 45 as follows:
(215 ILCS 111/15)
Sec. 15. Definitions. As used in this Act:
"Department" means the Department of Insurance.
"Director" means the Director of Insurance.
"Dental care provider" means a dentist who bills for
services in Illinois.
"Dental 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 dental 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,
a voluntary health services plan, or any other entity
providing a plan of dental insurance, dental benefits, or
dental health care services.

SB3721 - 2 - LRB103 38525 RPS 68661 b
"Portal" means a website or reasonably similar method of
sharing information that (i) is compliant with the federal
Health Insurance Portability and Accountability Act of 1996
and the regulations promulgated thereunder, (ii) provides
resources and information to dentists and subscribers, and
(iii) is compatible with dental software so universal
accessibility may be achieved.
(Source: P.A. 102-146, eff. 7-23-21.)
(215 ILCS 111/20)
Sec. 20. Uniform electronic claims and eligibility
transactions required.
(a) Beginning January 1, 2027 2025, no dental plan carrier
is required to accept from a dental care provider eligibility
for a dental plan transaction or dental care claims or
equivalent encounter information transaction except as
provided in this Act.
(b) All dental plan carriers and dental care providers
must exchange claims and eligibility information
electronically using the 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 dental plan carrier.
(Source: P.A. 102-146, eff. 7-23-21.)

SB3721 - 3 - LRB103 38525 RPS 68661 b
(215 ILCS 111/25)
Sec. 25. Rules; modification of rules.
(a) The Department may shall adopt rules as necessary to
implement this Act and may establish further exemptions to
this Act by rule.
(b) A dental plan carrier or dental care provider may not
add to or modify the uniform electronic claims and eligibility
requirements adopted by the Department.
(Source: P.A. 102-146, eff. 7-23-21.)
(215 ILCS 111/30 new)
Sec. 30. Exemptions. Notwithstanding any other provision
of this Act, a dental care provider shall not be required to
submit claims electronically under any of the following
circumstances:
(1) The dental care provider is with a dental practice
that, including the dental care provider, employs 4 or
fewer full-time or full-time equivalent employees.
(2) There is a temporary technological or electrical
failure that prevents a claim from being submitted
electronically.
(3) The dental care provider graduated from a dental
school in 1985 or before.
(4) The dental care provider graduated from a dental
school within 10 years before the effective date of this
amendatory Act of the 103rd General Assembly and meets one

SB3721 - 4 - LRB103 38525 RPS 68661 b
of the following criteria:
(A) The dental care provider started his or her
own practice.
(B) The dental care provider has purchased a
practice that has been previously exempted from the
requirements of this Act.
(5) The dental care provider demonstrates financial
difficulties in buying or managing an electronic claims
submission software system.
(6) The dental care provider has a disability or
medical reason that prohibits the dental care provider
from submitting claims electronically.
(7) The dental care provider is a temporary dentist
operating a practice for another dentist who is
temporarily unable to practice.
(8) There are other unforeseen practice disruptions,
including, but not limited to, natural disasters, physical
damage to the practice, or damage to the data system.
A dental care provider who is exempted from filing claims
electronically under this Section shall file a form with the
Department indicating the applicable exemption. The Department
shall provide the form no later than January 1, 2027.
(215 ILCS 111/35 new)
Sec. 35. Eligibility and benefit verification portal.
(a) Each dental plan carrier shall establish a portal as

SB3721 - 5 - LRB103 38525 RPS 68661 b
described in this Section and shall include information about
each type of subscription contract that is sufficient to allow
subscribers and dentists to determine the covered services
under each subscription contract and the payment or
reimbursement amounts for those covered services at the
procedure level. The information in the portal shall include
the following, as appropriate:
(1) Effective date of plan.
(2) Status of plan.
(3) Termination date of plan.
(4) Coordination of benefits; standard or
non-duplicating.
(5) Claim address.
(6) Payer identification.
(7) Covered services.
(8) Whether a deductible applies and to which
services.
(9) Remaining deductible: family.
(10) Remaining deductible: individual.
(11) Preferred in-network co-insurance amount.
(12) In-network co-insurance amount.
(13) Out-of-network co-insurance amount.
(14) Preferred in-network co-payment amount.
(15) In-network co-payment amount.
(16) Out-of-network co-payment amount.
(17) Remaining plan maximum.

SB3721 - 6 - LRB103 38525 RPS 68661 b
(18) Remaining lifetime maximum.
(19) Last treatment plan payment date applied to the
annual maximum or deductible to help determine if a
benefit has been used outside of the primary office.
(20) Age limitation.
(21) Frequency limit by time period.
(22) Frequency limit by tooth number.
(23) Next available service date based on any
frequency limit due to prior treatment history or added
custom benefits, such as medical conditions and roll-over.
(24) Whether there is a missing tooth clause.
(25) Number of quads benefited per visit.
(26) Waiting period due to preexisting condition or
missing tooth limitation.
(27) Prior authorization requirements.
(28) Processing policies, such as bundling,
downcoding, least expensive alternative treatment
requirements, fees disallowed in conjunction with other
treatments, and limitations by location.
(29) A comprehensive list of all current American
Dental Association Codes stating if they are covered, the
percentage of coverage, and if there are any conditions
that preclude coverage.
(b) At minimum, the portal shall provide current and
accurate real-time benefit eligibility and benefits
information. It is the responsibility of the dental plan

SB3721 - 7 - LRB103 38525 RPS 68661 b
carrier to ensure patient eligibility and benefits reporting
is timely and accurate.
(215 ILCS 111/40 new)
Sec. 40. Dental plan carrier requirements. A dental plan
carrier must:
(1) Provide an electronic portal that is compliant
with the federal Health Insurance Portability and
Accountability Act of 1996 and the regulations promulgated
thereunder and that allows dental care providers to submit
claims electronically and directly to dental plan carrier.
The portal shall be provided free of charge to the dental
care provider.
(2) Accept attachments, including, but not limited to,
x-rays and other supporting information for claims, in an
electronic format with the initial electronic claim's
submission and any further submissions thereafter.
(3) Provide remittance advice with the corresponding
payment that outlines individually per claim: the name of
the patient; the date of service; the service code or, if
no service code is available, a service description; the
amount being paid; the claim number; and other identifying
claim information found on an explanation of benefits
form.
(215 ILCS 111/45 new)

SB3721 - 8 - LRB103 38525 RPS 68661 b
Sec. 45. Payment. Nothing in this Act requires a dental
care provider to only accept electronic payment from a dental
plan carrier. Dental plan carriers shall allow alternative
forms of payment, without additional fees or charges, to a
dental care provider, if requested.