HBA-MSH H.B. 2826 77(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 2826
By: Smithee
Insurance
4/26/2001
Introduced



BACKGROUND AND PURPOSE 

Current law provides for a uniform claim billing form to be used by health
care providers, however  there is no such uniform explanation of payment
form for use by health carriers.  The result is a number of forms with
differing formats, information, and terminology making it difficult for
healthcare providers to determine whether the health carrier paid the
correct amount.  This increases administrative costs, which are ultimately
passed on to patients in the form of higher health insurance premiums or
deductibles and co-pays.  House Bill 2826 creates a uniform explanation of
payment form and requires its use by health carriers. 

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the commissioner of insurance in
SECTION 1 (Article 21.52, Insurance Code) and SECTION 2 of this bill. 

ANALYSIS

House Bill 2826 amends the Insurance Code to add health care entities to
the definition of provider for purposes of uniform claim billing and
payment forms.  The bill requires the commissioner of insurance
(commissioner) by rule to adopt a single uniform explanation of payment
form (form) and by rule to define the terminology used in that form. The
bill requires each health carrier to use the form and send it to a provider
with any payment for a claim.   The bill provides that the form must
contain the information necessary for the provider to be able to determine
if the amount of the payment made is correct. If there is a contract
between the health carrier and the provider, the form must also contain any
information necessary for the provider to determine if the amount of
payment is correct according to the terms of the contract.  The bill
requires a health carrier to send the form to a provider in the same manner
required for transmission of the claim payment.  The bill requires the
commissioner to adopt the necessary rules not later than December 1, 2001. 

EFFECTIVE DATE

September 1, 2001.  The Act applies only to a claim under a health benefit
plan that is filed with a health carrier on or after January 1, 2002.