HB 731

Abstract

Amends the Illinois Insurance Code. In the provisions regarding recoupments, removes the requirement that a remittance advice be provided to a health care provider. Provides that except in cases of fraud, all claims paid by an insurer or other specified organization shall be considered final unless adjustments are made pursuant to the Act. Provides that if an insurer or other specified organization determines that it has made an overpayment to a provider, the insurer must give the provider a written statement specifying the basis for the claim of overpayment. Sets forth recoupment provisions for situations where (i) there is a contract between the provider and the insurer and (ii) there is no contract between the provider and the insurer. Provides that an insurer or other specified organization shall not seek recoupment for payment of a claim based on any claimed lack of medical necessity if the insurer has received the provider's treatment records. Provides that an insurer or other specified organization shall not offset payment for claims for services to a patient against claims for the provider's services to any other patient. Makes other changes.