| ||||
| Public Act 102-0146 | ||||
| ||||
| ||||
AN ACT concerning regulation.
| ||||
Be it enacted by the People of the State of Illinois,
| ||||
represented in the General Assembly:
| ||||
Section 1. Short title. This Act may be cited as the | ||||
Uniform Electronic Transactions in Dental Care Billing Act. | ||||
Section 5. Purpose. The purpose of this Act is to | ||||
standardize the forms used in the billing and reimbursement of | ||||
dental care, reduce the number of forms used, increase | ||||
efficiency in the reimbursement of dental care through | ||||
standardization, and encourage the use of and prescribe a | ||||
timetable for implementation of electronic data interchange of | ||||
dental care expenses and reimbursement. | ||||
Section 10. Applicability. Except as may be otherwise | ||||
specifically provided, this Act applies to all dental plan | ||||
carriers. | ||||
Section 15. Definitions. As used in this Act:
| ||||
"Department" means the Department of Insurance.
| ||||
"Director" means the Director of Insurance.
| ||||
"Dental care provider" means a dentist who bills for | ||||
services in Illinois.
| ||||
"Dental plan carrier" means an entity subject to the | ||||
insurance laws and regulations of this State or subject to the | ||
jurisdiction of the Director that contracts or offers to | ||
contract to provide, deliver, arrange for, pay for, or | ||
reimburse any of the costs of dental care services, including | ||
an accident and health insurance company, a health maintenance | ||
organization, a limited health service organization, a dental | ||
service plan corporation, a health services plan corporation, | ||
a voluntary health services plan, or any other entity | ||
providing a plan of dental insurance, dental benefits, or | ||
dental health care services. | ||
Section 20. Uniform electronic claims and eligibility | ||
transactions required.
| ||
(a) Beginning January 1, 2025, no dental plan carrier is | ||
required to accept from a dental care provider eligibility for | ||
a dental plan transaction or dental care claims or equivalent | ||
encounter information transaction except as provided in this | ||
Act.
| ||
(b) All dental plan carriers and dental care providers | ||
must exchange claims and eligibility information | ||
electronically using the standard electronic data interchange | ||
transactions for claims submissions, payments, and | ||
verification of benefits required under the Health Insurance | ||
Portability and Accountability Act in order to be compensable | ||
by the dental plan carrier.
| ||
Section 25. Rules; modification of rules.
| ||
(a) The Department shall adopt rules as necessary to | ||
implement this Act and may establish exemptions to this Act by | ||
rule.
| ||
(b) A dental plan carrier or dental care provider may not | ||
add to or modify the uniform electronic claims and eligibility | ||
requirements adopted by the Department.
| ||
Section 99. Effective date. This Act takes effect upon | ||
becoming law. | ||