376.1400. Explanation of benefits, standardized information used, contents, when. - Missouri Statutes

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

376.1400. 1. Every health insurance carrier offering policies ofinsurance in this state shall use standardized information for the explanationof benefits given to the health care provider whenever a claim is paid ordenied. As used in this section, the term "health insurance carrier" shallhave the meaning given to "health carrier" in section 376.1350. Nothing inthis section shall apply to accident-only, specified disease, hospitalindemnity, Medicare supplement, long-term care, short-term major medicalpolicies of six months or less duration, other limited benefit healthinsurance 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 ofbenefits.

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

(L. 1999 H.B. 191)