376.1400. Explanation of benefits, standardized information used, contents, when.

183 words·~1 min read·/mo/chapter-376/376-1400

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376.1400. Explanation of benefits, standardized information used, contents, when. — 1. Every health insurance carrier offering policies of insurance in this state shall use standardized information for the explanation of benefits given to the health care provider whenever a claim is paid or denied. As used in this section, the term "health insurance carrier" shall have the meaning given to "health carrier" in section 376.1350 . Nothing in this section shall apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, short-term major medical policies of six months or less duration, other limited benefit health insurance policies.

2. The standardized information shall contain the following:

(1)The name of the insured;

(2)The insured's identification number;

(3)The date of service;

(4)Amount of charge;

(5)Explanation for any denial;

(6)The amount paid;

(7)The patient's full name;

(8)The name and address of the insurer; and

(9)The phone number to contact for questions on explanation of benefits.

3. All health insurance carriers shall use the standard explanation of benefits information after January 1, 2002.

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(L. 1999 H.B. 191)