Section 374.184

Title XXIV BUSINESS AND FINANCIAL INSTITUTIONS

Chapter 374

Effective - 28 Aug 1992   

  374.184.  Director to prescribe by rule uniform claim forms for reporting — consultation, hearing — contents of forms — companies may request additional information — effective date of regulations. — 1.  The director of the department of commerce and insurance shall prescribe by rule, after due consultation with providers of health care or treatment and their respective licensing boards, accident and sickness insurers, health services corporations and health maintenance organizations, and after a public hearing, uniform claim forms for reporting by health care providers.  Such prescribed forms shall include but need not be limited to information regarding the medical diagnosis, treatment and prognosis of the patient, together with the details of charges incident to the providing of such care, treatment or services, sufficient for the purpose of meeting the proof requirements of an accident and sickness insurance or hospital, medical or dental services contract.  Such prescribed forms shall be based upon the UB-82 form, with respect to hospital claims, and the HCFA 1500 form, with respect to physician claims, as such forms are modified or amended from time to time by the National Uniform Billing Committee or the federal Health Care Financing Administration.

  2.  The adoption of any uniform claim forms by the director pursuant to this section shall not preclude an insurer, health services corporation, or health maintenance organization from requesting any necessary additional information in connection with a claims investigation from the claimant, provider of health care or treatment, or certifier of coverage.  The provisions of this section shall not be deemed or construed to apply to electronic claims submission.  Insurers and providers may by contract provide for modifications to the uniform billing document where both insurers and providers feel that such modifications streamline claims processing procedures relating to the claims of the insurer involved in such contract modification.  However, a refusal by the provider to agree to modification of the uniform billing format shall not be used by the insurer as grounds for refusing to enter into a contract with the provider for reimbursement or payment for health services rendered to an insured of the insurer.

  3.  Rules adopted or promulgated pursuant to this act^* shall be subject to notice and hearing as provided in chapter 536.  The regulations so adopted shall specify an effective date, which shall not be less than one hundred eighty days after the date of adoption, after which no accident and sickness insurer, health services corporation or health maintenance organization shall require providers of health care or treatment to complete forms differing from those prescribed by the director pursuant to this section, and after which no health care provider shall submit claims except upon such prescribed forms; provided that the provisions of this section shall not preclude the use by any insurer, health services corporation or health maintenance organization of the UB-82 form or the HCFA 1500 form.

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(L. 1992 S.B. 796 § 13)

*"This act" (S.B. 796, 1992) contained numerous sections. Consult Disposition of Sections table for a definitive listing.