31A-22-614.5 - Uniform claims processing -- Electronic exchange of health information.
31A-22-614.5. Uniform claims processing -- Electronic exchange of healthinformation.
(1) (a) Except as provided in Subsection (1)(c), all insurers offering health insuranceshall use a uniform claim form and uniform billing and claim codes.
(b) Beginning January 1, 2011, all health benefit plans, and dental and vision plans, shallprovide for the electronic exchange of uniform:
(i) eligibility and coverage information; and
(ii) coordination of benefits information.
(c) For purposes of Subsection (1)(a), "health insurance" does not include a policy orcertificate that provides benefits solely for:
(i) income replacement; or
(ii) long-term care.
(2) (a) The uniform electronic standards and information required in Subsection (1) shallbe adopted and approved by the commissioner in accordance with Title 63G, Chapter 3, UtahAdministrative Rulemaking Act.
(b) When adopting rules under this section the commissioner:
(i) shall:
(A) consult with national and state organizations involved with the standardizedexchange of health data, and the electronic exchange of health data, to develop the standards forthe use and electronic exchange of uniform:
(I) claim forms;
(II) billing and claim codes;
(III) insurance eligibility and coverage information; and
(IV) coordination of benefits information; and
(B) meet federal mandatory minimum standards following the adoption of nationalrequirements for transaction and data elements in the federal Health Insurance Portability andAccountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936;
(ii) may not require an insurer or administrator to use a specific software product orvendor; and
(iii) may require an insurer who participates in the all payer database created underSection 26-33a-106.1 to allow data regarding demographic and insurance coverage information to be electronically shared with the state's designated secure health information master personindex to be used:
(A) in compliance with data security standards established by:
(I) the federal Health Insurance Portability and Accountability Act of 1996, Pub. L.104-191, 110 Stat. 1936; and
(II) the electronic commerce agreements established in a business associate agreement;and
(B) for the purpose of coordination of health benefit plans.
(3) (a) The commissioner shall coordinate the administrative rules adopted under theprovisions of this section with the administrative rules adopted by the Department of Health forthe implementation of the standards for the electronic exchange of clinical health informationunder Section 26-1-37. The department shall establish procedures for developing the rulesadopted under this section, which ensure that the Department of Health is given the opportunityto comment on proposed rules.
(b) (i) The commissioner may provide information to health care providers regardingresources available to a health care provider to verify whether a health care provider's practicemanagement software system meets the uniform electronic standards for data exchange requiredby this section.
(ii) The commissioner may provide the information described in Subsection (3)(b)(i) bypartnering with:
(A) a not-for-profit, broad based coalition of state health care insurers and health careproviders who are involved in the electronic exchange of the data required by this section; or
(B) some other person that the commissioner determines is appropriate to provide theinformation described in Subsection (3)(b)(i).
(c) The commissioner shall regulate any fees charged by insurers to the providers for:
(i) uniform claim forms;
(ii) electronic billing; or
(iii) the electronic exchange of clinical health information permitted by Section 26-1-37.
Amended by Chapter 357, 2010 General Session