SB 425

  • Virginia Senate Bill
  • 2024 Regular Session
  • Introduced in Senate Jan 09, 2024
  • Passed Senate Jan 26, 2024
  • Passed House Feb 20, 2024
  • Signed by Governor Mar 28, 2024

Health insurance; ethics and fairness in carrier business practices.

Abstract

Health insurance; ethics and fairness in carrier business practices. Makes various changes to requirements governing the business practices of health carriers in the processing and payment of claims. The bill prescribes criteria for what constitutes a "clean claim." The bill prohibits a carrier from imposing any retroactive denial of a previously paid claim or in any other way seeking recovery or refund of a previously paid claim unless the carrier specifies in writing the specific claim or claims for which the retroactive denial is to be imposed or the recovery or refund is sought and the carrier has provided a written explanation of why the claim is being retroactively adjusted. The bill provides that the time limit for a retroactive denial is 12 months; however, a provider and a carrier may agree in writing that recoupment of overpayments by withholding or offsetting against future payments may occur after such 12-month limit. The bill requires carriers, beginning no later than July 1, 2025, to make available an electronic means for providers to determine whether an enrollee is covered by a health plan that is subject to the State Corporation Commission's jurisdiction. The bill provides that the ethics and fairness requirements apply to the carrier and provider, regardless of any vendors, subcontractors, or other entities that have been contracted by the carrier or the provider to perform their duties. The bill provides that if a carrier's claim denial is overturned following completion of a dispute review, the carrier is required to consider the claims impacted by such decision as clean claims and all applicable laws related to the payment of a clean claim apply. The bill prohibits a provider from filing a complaint with the State Corporation Commission for failure to pay claims unless such provider has made a reasonable effort to confer with the carrier in order to resolve the issues related to all claims that are under dispute. Finally, the bill requires all provider contracts, amendments, and notices and certain other communications to be delivered electronically. This bill is identical to HB 123.

Health insurance; ethics and fairness in carrier business practices. Makes various changes to requirements governing the business practices of health carriers in the processing and payment of claims. The bill prescribes criteria for what constitutes a "clean claim". The bill provides that the time limit for a retroactive denial is 12 months; however, a provider and a carrier may agree in writing that recoupment of overpayments by withholding or offsetting against future payments may occur after such 12 month-limit. The bill requires carriers, beginning July 1, 2025, to make available an electronic means for providers to determine whether an enrollee is covered by a health plan. The bill provides that the ethics and fairness requirements apply to the carrier and provider, regardless of any vendors, subcontractors, or other entities that have been contracted by the carrier or the provider to perform their duties. The bill provides that if a carrier's claim denial is overturned following completion of a dispute review, the carrier is required to consider the claims impacted by such decision as clean claims and all applicable laws related to the payment of a clean claim apply. The bill prohibits a provider from filing a complaint with the State Corporation Commission for failure to pay claims unless such provider has made a reasonable effort to confer with the carrier in order to resolve the issues related to all claims that are under dispute. Finally, the bill requires all provider contracts, amendments, and notices and certain other communications to be delivered electronically.

Bill Sponsors (1)

Votes


Actions


Mar 28, 2024

Office of the Governor

Approved by Governor-Chapter 244 (effective 7/1/24)

Office of the Governor

Acts of Assembly Chapter text (CHAP0244)

Mar 11, 2024

Senate

Enrolled Bill Communicated to Governor on March 11, 2024

Office of the Governor

Governor's Action Deadline 11:59 p.m., April 8, 2024

Mar 05, 2024

Senate

Impact statement from SCC (SB425ER)

Feb 29, 2024

Senate

Signed by President

Feb 26, 2024

Senate

Enrolled

House

Signed by Speaker

Senate

Bill text as passed Senate and House (SB425ER)

Feb 20, 2024

House

Passed House BLOCK VOTE (98-Y 0-N)

House

VOTE: Block Vote Passage (98-Y 0-N)

House

Read third time

Feb 19, 2024

House

Read second time

Feb 15, 2024

House

Reported from Labor and Commerce (19-Y 0-N)

Feb 13, 2024

House

Referred to Committee on Labor and Commerce

House

Placed on Calendar

House

Read first time

Jan 26, 2024

Senate

Impact statement from SCC (SB425S1)

Senate

Read third time and passed Senate (38-Y 0-N)

Jan 25, 2024

Senate

Engrossed by Senate - committee substitute SB425S1

Senate

Read second time

Senate

Committee substitute agreed to 24105801D-S1

Senate

Reading of substitute waived

Jan 24, 2024

Senate

Constitutional reading dispensed (40-Y 0-N)

Jan 22, 2024

Senate

Senate committee, floor amendments and substitutes offered

Senate

Committee substitute printed 24105801D-S1

Senate

Reported from Commerce and Labor with substitute (15-Y 0-N)

Jan 20, 2024

Senate

Impact statement from SCC (SB425)

Jan 09, 2024

Senate

Referred to Committee on Commerce and Labor

Senate

Prefiled and ordered printed; offered 01/10/24 24102577D

Bill Text

Bill Text Versions Format
Prefiled and ordered printed; offered 01/10/24 24102577D PDF HTML
Committee substitute printed 24105801D-S1 PDF HTML
SB425ER PDF HTML
CHAP0244 PDF HTML

Related Documents

Document Format
Fiscal Impact Statement: SB425FER171.PDF PDF
Fiscal Impact Statement: SB425FS1171.PDF PDF
Fiscal Impact Statement: SB425F171.PDF PDF

Sources

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