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1997 SESSION

977735693
SENATE BILL NO. 1123
Senate Amendments in [ ] -- February 4, 1997
A BILL to amend and reenact § 38.2-322 of the Code of Virginia, relating to health insurer, health maintenance organizations, health service plans, etc.; reporting and accepting claims forms.
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Patrons-- Lambert, Holland, Reasor, Schrock and Trumbo; Delegate: O'Brien
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Referred to the Committee on Commerce and Labor
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Be it enacted by the General Assembly of Virginia:

1. That § 38.2-322 of the Code of Virginia is amended and reenacted as follows:

§ 38.2-322. Standardized claims forms.

A. No accident and sickness insurer, health maintenance organization, health services plan, or optometric services plan licensed in the Commonwealth shall refuse to accept, as a standard claims form for physician services or for services provided by chiropractors, optometrists, opticians, professional counselors, psychologists, clinical social workers, podiatrists, physical therapists, clinical nurse specialists who render mental health services, audiologists, and speech pathologists, the standardized HCFA-1500 health insurance claims form, or its successor as it may be amended from time to time. However, nothing in this section shall prohibit an insurer, health maintenance organization, health services plan, or optometric services plan from accepting any other claims form.

B. No accident and sickness insurer, health maintenance organization, or health services plan licensed in the Commonwealth shall refuse to accept as a standard claims form for hospital services the standardized UB-82 claims form, or its successor as it may be amended from time to time. However, nothing in this section shall prohibit an accident and sickness insurer, health maintenance organization, or health services plan from accepting any other claims form.

C. No accident and sickness insurer, health maintenance organization, health services plan, or dental services plan licensed in the Commonwealth shall refuse to accept as a standard claims form for dental services the standardized ADA form prepared by the American Dental Association, or its successor as it may be amended from time to time. However, nothing in this section shall prohibit an accident and sickness insurer, health maintenance organization, health services plan, or dental services plan from accepting any other claims form.

D. The forms specified in this section may be modified as necessary to accommodate the transmission and administration of claims by electronic means.

E. [ Any No ] health maintenance organization authorized to transact business in this Commonwealth and any health insurer, [ hospital service corporation, ] health services plan or preferred provider organization authorized to offer health benefits in this Commonwealth that requires the use of the Physicians' Current Procedural Terminology (CPT) identifying codes published by the American Medical Association for reporting claims for medical services and procedures, including any standardized form, shall [ refuse to ] accept and utilize these identifying codes [ when appropriately utilized ] and any appropriate modifiers listed therein [ when appropriately utilized ] for processing such claims for [ medical provider ] services and procedures.