HB 495: Health Care Amendments - Utah

Enrolled → Amended Excerpts 2/26/2025 10:02:293 · 4 edits

MODERATE

This bill amendment adds a requirement for insurers to accept tangible checks as payment and modifies dental billing rules to prevent insurers from preventing providers from collecting contracted fees from patients. The changes aim to improve payment flexibility for providers and ensure patients can be billed for services when insurers deny claims.

REQUIREMENT

Insurers must now allow tangible checks as a form of acceptable payment for health care claims, expanding payment options beyond credit cards and electronic arrangements.

Dental plans cannot use downcoding practices that prevent providers from collecting their contracted fees from patients for services actually performed.

Dental plans cannot prevent providers from seeking payment from patients when the insurer denies a claim, unless the service should not be billed under generally accepted practice standards.

TIMELINE

Automatic recoupment of overpayments by dental plans is now prohibited until January 1, 2026, unless the provider elects earlier recoupment.

Amended Excerpts 2/26/2025 10:02:293 → Amended 2/26/2025 10:02:293 · 4 edits

MODERATE

This bill amends Utah's health care claims practices to clarify payment timelines, define who qualifies as an insurer and provider, and establish rules for handling claim denials and extensions. The changes aim to ensure timely payment of valid claims and provide clearer standards for when insurers can extend decision deadlines.

Scope change

The bill expands the scope by adding specific definitions for 'insurer' and 'provider' and clarifies payment obligations for health maintenance organizations and third-party administrators.

DEFINITION

Added clear definitions for 'insurer' (including health maintenance organizations and third-party administrators) and 'provider' to clarify who must follow payment rules.

TIMELINE

Modified claim payment timelines, requiring insurers to pay or deny claims within 30 days for standard claims and 45 days for income replacement benefits, with specific extension rules.

REQUIREMENT

Added requirements for insurers to provide written explanations when denying claims and to notify providers or insureds of extension reasons and expected decision dates.

ELIGIBILITY

Modified eligibility criteria by clarifying that third-party administrators must have claims funded by the entity they represent, preventing use of their own funds for unfunded claims.

Introduced → Enrolled · 5 edits · Mar 26, 2025

MODERATE

This bill updates Utah's health care claims practices to improve transparency and payment timelines for insurers and providers. It clarifies rules about credit card payments, strengthens dental claim protections against billing practices like bundling and downcoding, and allows dentists to dispense certain medications on-site.

Scope change

The bill expands the scope of dental claim transparency requirements and adds new provisions allowing dentists to dispense prescription medications under specific conditions.

REQUIREMENT

Updated credit card payment rules to allow providers to opt out of credit card remittance arrangements and require insurers to accept tangible checks as payment.

Added new dental claim transparency requirements including online availability of dental plan policies, disclosure of bundling and downcoding practices, and limits on automatic recoupment of overpayments.

ELIGIBILITY

Added eligibility for dentists to dispense prescription medications at their offices under specific conditions, including a 30-day supply limit and requirements for patient disclosure.

DEFINITION

Added new definitions for 'dispense,' 'dispensing practitioner,' and 'licensed dispensing practice' to support the new medication dispensing provisions.

TIMELINE

Maintained existing claim payment timelines (30 days for standard claims, 45 days for income replacement) but clarified extension procedures and late fee calculations.

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