No. 27784: R590-164. Uniform Health Billing Rule

DAR File No.: 27784
Filed: 03/31/2005, 01:43
Received by: NL

 

NOTICE OF REVIEW AND STATEMENT OF CONTINUATION

Concise explanation of the particular statutory provisions under which the rule is enacted and how these provisions authorize or require the rule:

Section 31A-22-614.5 requires all insurers that offer health insurance to use a uniform claim form and uniform billing and claim codes adopted by the commissioner in accordance with the Utah Administrative Rulemaking Act. In Subsection R590-164-4(A), the rule sets the electronic claim forms to be used uniformly and Section R590-164-6 sets the standards for electronic data interchange transaction between providers of health services and health insurers.

 

Summary of written comments received during and since the last five-year review of the rule from interested persons supporting or opposing the rule:

On October 28, 2002, the department filed this rule correcting definitions and incorporating additional electronic interchange standards. During the comment period, the department received three written comments. One explained the process being used to set the health billing standards, who was involved, and how the information was being exposed to the public. Another comment expressed concern that the process amounted to a monopoly and that the process did not allow for public comment. An insurer who was not aware that their company was represented on the committee setting standards suggested that the state adopt Health Insurance Portability and Accountability Act (HIPAA) standards and that only a few members of the standards committee are affected by those same standards.

 

Reasoned justification for continuation of the rule, including reasons why the agency disagrees with comments in opposition to the rule, if any:

This rule eliminates the need for every insurer to create their own billing form that health providers are required to complete and file before receiving reimbursement for their services. Uniformity in health billing forms reduces confusion, processing time, and cost. Therefore, this rule should be continued. It should be noted that the organization that sets the standards has representation from major insurance carriers and health care providers. Before adopting standards, they are exposed to the insurance industry and medical organizations for their input. As many as 700 responses have been received regarding a change in standards. Utah exceeds the national average of those participating electronically in the exchange of health billings. Ninety percent of medical billings in Utah are sent electronically.

 

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Insurance
Administration
Room 3110 STATE OFFICE BLDG
450 N MAIN ST
SALT LAKE CITY UT 84114-1201

 

Direct questions regarding this rule to:

Jilene Whitby at the above address, by phone at 801-538-3803, by FAX at 801-538-3829, or by Internet E-mail at [e-mail]

 

Authorized by:

Jilene Whitby, Information Specialist