HBA-MSH H.B. 2826 77(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 2826 By: Smithee Insurance 4/26/2001 Introduced BACKGROUND AND PURPOSE Current law provides for a uniform claim billing form to be used by health care providers, however there is no such uniform explanation of payment form for use by health carriers. The result is a number of forms with differing formats, information, and terminology making it difficult for healthcare providers to determine whether the health carrier paid the correct amount. This increases administrative costs, which are ultimately passed on to patients in the form of higher health insurance premiums or deductibles and co-pays. House Bill 2826 creates a uniform explanation of payment form and requires its use by health carriers. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the commissioner of insurance in SECTION 1 (Article 21.52, Insurance Code) and SECTION 2 of this bill. ANALYSIS House Bill 2826 amends the Insurance Code to add health care entities to the definition of provider for purposes of uniform claim billing and payment forms. The bill requires the commissioner of insurance (commissioner) by rule to adopt a single uniform explanation of payment form (form) and by rule to define the terminology used in that form. The bill requires each health carrier to use the form and send it to a provider with any payment for a claim. The bill provides that the form must contain the information necessary for the provider to be able to determine if the amount of the payment made is correct. If there is a contract between the health carrier and the provider, the form must also contain any information necessary for the provider to determine if the amount of payment is correct according to the terms of the contract. The bill requires a health carrier to send the form to a provider in the same manner required for transmission of the claim payment. The bill requires the commissioner to adopt the necessary rules not later than December 1, 2001. EFFECTIVE DATE September 1, 2001. The Act applies only to a claim under a health benefit plan that is filed with a health carrier on or after January 1, 2002.