374.184. Director to prescribe by rule uniform claim forms for reporting--consultation, hearing--contents of forms--companies may request additional information--effective date of regulations.

MISSOURI STATUTES AND CODES

374.184. Director to prescribe by rule uniform claim forms for reporting--consultation, hearing--contents of forms--companies may request additional information--effective date of regulations.

Director to prescribe by rule uniform claim forms forreporting--consultation, hearing--contents of forms--companiesmay request additional information--effective date ofregulations.

374.184. 1. The director of the department of insurance, financialinstitutions and professional registration shall prescribe by rule, after dueconsultation with providers of health care or treatment and their respectivelicensing boards, accident and sickness insurers, health services corporationsand health maintenance organizations, and after a public hearing, uniformclaim forms for reporting by health care providers. Such prescribed formsshall include but need not be limited to information regarding the medicaldiagnosis, treatment and prognosis of the patient, together with the detailsof charges incident to the providing of such care, treatment or services,sufficient for the purpose of meeting the proof requirements of an accidentand sickness insurance or hospital, medical or dental services contract. Suchprescribed forms shall be based upon the UB-82 form, with respect to hospitalclaims, and the HCFA 1500 form, with respect to physician claims, as suchforms are modified or amended from time to time by the National UniformBilling Committee or the federal Health Care Financing Administration.

2. The adoption of any uniform claim forms by the director pursuant tothis section shall not preclude an insurer, health services corporation, orhealth maintenance organization from requesting any necessary additionalinformation in connection with a claims investigation from the claimant,provider of health care or treatment, or certifier of coverage. Theprovisions of this section shall not be deemed or construed to apply toelectronic claims submission. Insurers and providers may by contract providefor modifications to the uniform billing document where both insurers andproviders feel that such modifications streamline claims processing proceduresrelating to the claims of the insurer involved in such contract modification.However, a refusal by the provider to agree to modification of the uniformbilling format shall not be used by the insurer as grounds for refusing toenter into a contract with the provider for reimbursement or payment forhealth services rendered to an insured of the insurer.

3. Rules adopted or promulgated pursuant to this act* shall be subjectto notice and hearing as provided in chapter 536, RSMo. The regulations soadopted shall specify an effective date, which shall not be less than onehundred eighty days after the date of adoption, after which no accident andsickness insurer, health services corporation or health maintenanceorganization shall require providers of health care or treatment to completeforms differing from those prescribed by the director pursuant to thissection, and after which no health care provider shall submit claims exceptupon such prescribed forms; provided that the provisions of this section shallnot preclude the use by any insurer, health services corporation or healthmaintenance organization of the UB-82 form or the HCFA 1500 form.