S.B. 60

1

HEALTH CARE - UNIFORM DATA
2 FORMATTING STANDARDS
3 2003 GENERAL SESSION
4 STATE OF UTAH
5 Sponsor: Gregory S. Bell
6 This act amends the Insurance Code. The act amends provisions related to health
7 insurance. The act authorizes the commissioner to establish uniform data formatting
8 standards to be used by health insurers and health care providers in electronic
9 transmissions and in nonelectronic transmissions. The act gives the commissioner
10 rulemaking authority.
11 This act affects sections of Utah Code Annotated 1953 as follows:
12 REPEALS AND REENACTS:
13 31A-22-614.5, as enacted by Chapter 255, Laws of Utah 1993
14 Be it enacted by the Legislature of the state of Utah:
15 Section 1. Section 31A-22-614.5 is repealed and reenacted to read:
16 31A-22-614.5. Health care administrative data and format standards.
17 (1) All insurers offering health insurance shall use uniform health care administrative
18 data and format standards upon the adoption of the standard by the commissioner pursuant to
19 Title 63, Chapter 46a, Utah Administrative Rulemaking Act.
20 (2) For purposes of Subsection (1):
21 (a) Uniform administrative data and format standards for nonelectronic data
22 interchange submissions shall include standards for claim forms, billing codes, and claim
23 codes.
24 (b) Uniform administrative data and format standards for electronic data interchange
25 submissions:
26 (i) shall, to the extent feasible, include standards for eligibility, coordination of
27 benefits, claims, claims status, the interchange of patient records and provider communications

28 containing protected health information, and a standard data set for provider credentialing and
29 other provider information; and
30 (ii) may include standards for other information that would facilitate efficient
31 communication between and among insurers and providers.
32 (c) In developing uniform health care data and format standards, the commissioner
33 shall:
34 (i) consult with appropriate national and local standards development organizations;
35 and
36 (ii) establish, on an as needed basis, an advisory panel of insurers and providers.
37 (3) (a) All insurers offering health insurance shall be able to send and receive
38 electronic data with providers using the uniform administrative data and format standards
39 adopted by the commissioner.
40 (b) An insurer may decline to accept an electronic data interchange submission from a
41 provider that does not adhere to the applicable electronic uniform administrative data and
42 format standard after the standard has been adopted under Subsection (1).
43 (4) The commissioner shall regulate any fees charged by insurers to providers for
44 electronic and nonelectronic data interchange submissions.
45 (5) Nothing in this section may be construed as:
46 (a) restricting or otherwise regulating electronic or nonelectronic data interchange
47 between insurers and entities other than providers;
48 (b) restricting the ability of an insurer and provider to communicate in a mutually
49 agreeable manner beyond the use of an applicable administrative data or format standard to
50 resolve an issue or concern that has arisen in an individual case; or
51 (c) imposing an administrative data or format standard if one has not been adopted.




Legislative Review Note
as of 1-15-03 11:23 AM

A limited legal review of this legislation raises no obvious constitutional or statutory concerns.

Office of Legislative Research and General Counsel