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H.B. 52 Enrolled






Chief Sponsor: Merlynn T. Newbold

Senate Sponsor: Peter C. Knudson

             8      LONG TITLE
             9      General Description:
             10          This bill amends provisions related to the use of uniform electronic standards for health
             11      insurance claims processing, insurance eligibility, and coordination of benefits.
             12      Highlighted Provisions:
             13          This bill:
             14          .    amends provisions related to uniform electronic standards for health insurance
             15      claims processing, electronic insurance eligibility information, and electronic
             16      information regarding the coordination of benefits;
             17          .    establishes a voluntary registry of software vendors who comply with electronic
             18      standards; and
             19          .    makes clarifying and technical amendments.
             20      Monies Appropriated in this Bill:
             21          None
             22      Other Special Clauses:
             23          None
             24      Utah Code Sections Affected:
             25      AMENDS:
             26          31A-22-614.5, as last amended by Laws of Utah 2008, Chapters 379 and 382
             28      Be it enacted by the Legislature of the state of Utah:
             29          Section 1. Section 31A-22-614.5 is amended to read:

             30           31A-22-614.5. Uniform claims processing -- Electronic exchange of health
             31      information.
             32          (1) (a) [Beginning July 1, 1993] Except as provided in Subsection (1)(c), all insurers
             33      offering health insurance shall use a uniform claim form and uniform billing and claim codes.
             34          (b) Beginning January 1, 2011, all health benefit plans, and dental and vision plans,
             35      shall provide for the electronic exchange of uniform:
             36          (i) eligibility and coverage information; and
             37          (ii) coordination of benefits information.
             38          (c) For purposes of Subsection (1)(a), "health insurance" does not include a policy or
             39      certificate that provides benefits solely for:
             40          (i) income replacement; or
             41          (ii) long-term care.
             42          (2) (a) The uniform [claim forms and billing codes] electronic standards and
             43      information required in Subsection (1) shall be adopted and approved by the commissioner in
             44      accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act. [The]
             45          (b) When adopting rules under this section the commissioner:
             46          (i) shall:
             47          (A) consult with [the director of the Division of Health Care Financing, the National
             48      Uniform Claim Form Task Force, and the National Uniform Billing Committee when adopting
             49      the uniform claims and billing codes.] national and state organizations involved with the
             50      standardized exchange of health data, and the electronic exchange of health data, to develop
             51      the standards for the use and electronic exchange of uniform:
             52          (I) claim forms;
             53          (II) billing and claim codes;
             54          (III) insurance eligibility and coverage information; and
             55          (IV) coordination of benefits information; and
             56          (B) meet federal mandatory minimum standards following the adoption of national
             57      requirements for transaction and data elements in the federal Health Insurance Portability and

             58      Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936;
             59          (ii) may not require an insurer or administrator to use a specific software product or
             60      vendor; and
             61          (iii) may require an insurer who participates in the all payer database created under
             62      Section 26-33a-106.1 to allow data regarding demographic and insurance coverage
             63      information to be electronically shared with the state's designated secure health information
             64      master person index to be used:
             65          (A) in compliance with data security standards established by:
             66          (I) the federal Health Insurance Portability and Accountability Act of 1996, Pub. L.
             67      104-191, 110 Stat. 1936; and
             68          (II) the electronic commerce agreements established in a business associate agreement;
             69      and
             70          (B) for the purpose of coordination of health benefit plans.
             71          [(3) (a) (i) Beginning July 1, 1995, all insurers shall offer compatible systems of
             72      electronic billing approved by the commissioner in accordance with Title 63G, Chapter 3,
             73      Utah Administrative Rulemaking Act.]
             74          [(ii) The systems approved by the commissioner may include monitoring and
             75      disseminating information concerning eligibility and coverage of individuals.]
             76          [(iii)] (3) (a) The commissioner shall coordinate the administrative rules adopted
             77      under the provisions of this section with the administrative rules adopted by the Department of
             78      Health for the implementation of the standards for the electronic exchange of clinical health
             79      information under Section 26-1-37 . The department shall establish procedures for developing
             80      the rules adopted under this section, which ensure that the Department of Health is given the
             81      opportunity to comment on proposed rules.
             82          (b) (i) The commissioner may provide information to health care providers regarding
             83      resources available to a health care provider to verify whether a health care provider's practice
             84      management software system meets the uniform electronic standards for data exchange
             85      required by this section.

             86          (ii) The commissioner may provide the information described in Subsection (3)(b)(i)
             87      by partnering with:
             88          (A) a not-for-profit, broad based coalition of state health care insurers and health care
             89      providers who are involved in the electronic exchange of the data required by this section; or
             90          (B) some other person that the commissioner determines is appropriate to provide the
             91      information described in Subsection (3)(b)(i).
             92          [(b)] (c) The commissioner shall regulate any fees charged by insurers to the providers
             93      for:
             94          (i) uniform claim forms;
             95          (ii) electronic billing; or
             96          (iii) the electronic exchange of clinical health information permitted by Section
             97      26-1-37 .

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