MISSISSIPPI LEGISLATURE
2014 Regular Session
To: Insurance
By: Representatives Taylor, Alday, Arnold, Barton, Boyd, Chism, Currie, Hamilton, Harrison, Kinkade, Staples, Turner
AN ACT TO DIRECT THE COMMISSIONER OF INSURANCE TO DEVELOP A UNIFORM HOSPITAL CLAIMS FORM THAT MEETS CERTAIN CRITERIA; TO REQUIRE EVERY HEALTH INSURANCE ISSUER THAT PROVIDES BENEFITS FOR HOSPITAL SERVICES TO USE AND ACCEPT ONLY THE UNIFORM HOSPITAL CLAIMS FORM DEVELOPED UNDER THIS ACT FOR ALL CLAIMS FOR REIMBURSEMENT OR INDEMNIFICATION FOR THE COST OF HOSPITAL SERVICES PROVIDED TO AN INSURED; TO PROVIDE THAT A PERSON MAY USE THE UNIFORM HOSPITAL CLAIMS FORM TO FILE A CLAIM WITH ANY HEALTH INSURANCE ISSUER WITH WHICH THE PERSON IS AN INSURED; TO AMEND SECTION 83-9-13, MISSISSIPPI CODE OF 1972, TO CONFORM TO THE PRECEDING PROVISIONS; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. (1) As used in this section:
(a) "Health benefit plan" means services consisting of medical care, provided directly, through insurance or reimbursement, or otherwise, and including items and services paid for as medical care under any hospital or medical service policy or certificate, hospital or medical service plan contract, preferred provider organization, or health maintenance organization contract offered by a health insurance issuer.
(b) "Health insurance issuer" means any entity that offers health insurance coverage through a health benefit plan, policy, or certificate of insurance subject to state law that regulates the business of insurance. "Health insurance issuer" also includes a health maintenance organization, as defined and regulated under Section 83-41-301 et seq.
(2) On and after January 1, 2015, every health insurance issuer that provides benefits for hospital services shall use and accept only the uniform hospital claims form developed under subsection (3) of this section for all claims for reimbursement or indemnification for the cost of hospital services provided to an insured. A person may use the uniform hospital claims form to file a claim with any health insurance issuer with which the person is an insured.
(3) The Commissioner of Insurance shall develop a uniform hospital claims form, which shall meet the following criteria:
(a) The form shall not exceed three (3) pages.
(b) The form shall be made available electronically by the Department of Insurance and the health benefit plan.
(c) The Commissioner of Insurance shall develop the form with input from health insurance issuers, consumer groups and other interested parties received in writing and at one or more public meetings.
(d) The Commissioner of Insurance, in developing the uniform hospital claims form, shall take into consideration the following:
(i) Any existing medical or hospital claims forms established by the federal Centers for Medicare and Medicaid Services and the Division of Medicaid.
(ii) Any national standards or draft standards pertaining to medical or hospital claims forms.
SECTION 2. Section 83-9-13, Mississippi Code of 1972, is amended as follows:
83-9-13. (1) The acknowledgment by any insurer of the receipt of notice given under any policy covered by Sections 83-9-1 through 83-9-21, or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim thereunder, shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under such policy.
(2) The Commissioner of Insurance shall prescribe the use of the National Uniform Bill-82 (UB-82) and the Health Care Financing Administration (HCFA) Form 1500 as the uniform proof of loss forms. After July 1, 1985, no insurance company writing policies of accident and sickness insurance may require proof of loss to be on any claim form but the UB-82 or HCFA Form 1500, whichever is appropriate for services rendered. However, insurance companies that provide benefits for hospital services shall use and accept only the uniform hospital claims form developed under Section 1 of this act for all claims for reimbursement or indemnification for the cost of hospital services provided to an insured.
(3) The Commissioner of Insurance shall review the uniform proof of loss forms prescribed under subsection (2), seek comments and suggestions from insurers and consumer groups about proposed improvements to the forms, and determine whether any revisions should be made to either form that would simplify or otherwise improve the form. If the commissioner determines that either form should be revised, he shall make the revisions to the form and prescribe the use of the revised form by all insurance companies writing policies of accident and sickness insurance in Mississippi. After six (6) months from the date that the commissioner has prescribed the use of any revised form, no insurance company writing policies of accident and sickness insurance may require proof of loss to be on any claim form but the revised form when that is the appropriate form for services rendered. However, insurance companies that provide benefits for hospital services shall use and accept only the uniform hospital claims form developed under Section 1 of this act for all claims for reimbursement or indemnification for the cost of hospital services provided to an insured.
SECTION 3. This act shall take effect and be in force from and after July 1, 2014.