No. 39174 (5-year Review): Rule R590-164. Uniform Health Billing Rule

DAR File No.: 39174
Filed: 03/10/2015 10:23:42 AM

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:

Subsection 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 Section R590-164-4, 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:

The department has not received any written comments regarding this rule in the past five years.

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

The rule is required by law, Section 31A-22-614.5. This rule eliminates the need for each insurer to create their own billing form that health providers are required to complete and file with the insurer before they can receive reimbursement for their services. Uniformity in health billing forms reduces confusion, processing time, and cost. 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. Ninety percent of medical billings in Utah are sent electronically, exceeding the national average. Therefore, this rule should be continued.

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:

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

Effective:

03/10/2015

Authorized by:

Todd Kiser, Commissioner

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