31A-22-637 - Health care provider payment information -- Notice of admissions. - Utah Statutes

31A-22-637. Health care provider payment information -- Notice of admissions.
(1) For purposes of this section, "insurer" is as defined in Section 31A-22-636.
(2) (a) An insurer shall provide its health care providers who are under contract with theinsurer access to current information necessary for the health care provider to determine:
(i) the effect of procedure codes on payment or compensation before a claim is submittedfor a procedure;
(ii) the plans and carrier networks that the health care provider is subject to as part of thecontract with the carrier; and
(iii) in accordance with Subsection 31A-26-301.6(10)(f), the specific rate and termsunder which the provider will be paid for health care services.
(b) The information required by Subsection (2)(a) may be provided through a website,and if requested by the health care provider, notice of the updated website shall be provided bythe carrier.
(3) (a) An insurer shall not require a health care provider by contract, reimbursementprocedure, or otherwise to notify the insurer of a hospital in-patient emergency admission withina period of time that is less than one business day of the hospital in-patient admission, ifcompliance with the notification requirement would result in notification by the health careprovider on a weekend or federal holiday.
(b) Subsection (3)(a) does not prohibit the applicability or administration of othercontract provisions between an insurer and a health care provider that require pre-authorizationfor scheduled in-patient admissions.

Enacted by Chapter 11, 2009 General Session