Sec. 38a-479. Definitions. Contracting health organizations to establish procedure allowing physicians to view fee schedules. Fee information to be confidential.
Sec. 38a-479. Definitions. Contracting health organizations to establish procedure allowing physicians to view fee schedules. Fee information to be confidential.
(a) As used in this section: (1) "Contracting health organization" means (A) a managed
care organization, as defined in section 38a-478, or (B) a preferred provider network,
as defined in section 38a-479aa; and (2) "physician" means a physician or surgeon,
chiropractor, podiatrist, psychologist or optometrist.
(b) Not later than October 1, 2007, each contracting health organization shall establish and implement a procedure reasonably designed to permit a physician, physician
group or physician organization under contract with such contracting health organization
to view, on a confidential basis, in a digital format or by electronic means, at the option
of such organization, the fee-for-service dollar amount such organization reimburses
pursuant to the organization's contract with the physician, physician group or physician
organization for the fifty current procedural terminology codes most commonly performed by the physician, physician group or physician organization.
(c) The procedure established by a contracting health organization shall also permit
a physician, physician group or physician organization to request and view fee-for-service dollar amounts the contracting health organization reimburses for current procedural terminology codes for which a physician, physician group or physician organization actually bills or intends to bill the contracting health organization, provided such
codes are within the physician's, group's or organization's specialty or subspecialty.
(d) The provisions of subsections (b) and (c) of this section shall not apply to any
physician, physician group or physician organization whose services are reimbursed in
a manner that does not utilize current procedural terminology codes.
(e) The fee information received by a physician, physician group or physician organization is proprietary and shall be confidential, and the procedure adopted pursuant to
this section may contain penalties for the unauthorized distribution of fee information,
which may include termination from the contracting health organization network.
(P.A. 06-178, S. 1; P.A. 07-54, S. 2.)
History: P.A. 07-54 made a technical change in Subsec. (c), effective May 22, 2007.