GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1993

S	2 

SENATE BILL 7
Insurance Committee Substitute Adopted 4/8/93

Short Title:  Uniform Ins. Claim Form.	(Public)
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January 28, 1993

A BILL TO BE ENTITLED
AN ACT TO REQUIRE THE COMMISSIONER OF INSURANCE TO DEVELOP AND REQUIRE UNIFORM FORMS FOR THE SUBMISSION OF CLAIMS UNDER HEALTH BENEFIT PLANS, TO ESTABLISH FEES FOR COPIES OF MEDICAL RECORDS, AND TO REQUIRE WRITTEN NOTICE OF CLAIM DENIAL.
The General Assembly of North Carolina enacts:
Section 1.  G.S. 58-50-10 is repealed.
Sec. 2. Article 3 of Chapter 58 of the General Statutes is amended by adding the following new sections to read:
"§ 58-3-170. Uniform claim forms.
(a)	All claims submitted by health care providers to health benefit plans shall be submitted on a uniform form or format that shall be developed by the Department and approved by the Commissioner.  Additional information beyond that contained on the uniform form or format may be collected subject to rules adopted by the Commissioner.  This section applies to the submission of claims in writing and by electronic means.
(b)	After consultation with the North Carolina Industrial Commission, the Commissioner may include workers' compensation insurance policies as 'health benefit plans' for the purpose of administering the provisions of this section.
(c)	For purposes of this section, 'health benefit plans' means accident and health insurance policies or certificates; nonprofit hospital or medical service corporation contracts; health maintenance organization (HMO) subscriber contracts and other plans provided by managed care organizations; plans provided by a MEWA or plans provided by other benefit arrangements, to the extent permitted by ERISA; the Teachers' and State Employees' Comprehensive Major Medical Plan; and medical payment coverages under homeowners and automobile insurance policies.
"§ 58-3-175. Notice of claim denied.
(a)	For all claims denied for heath care provider services under health benefit plans, written notification of the denied claim shall be given to the insured and to the health care provider submitting the claim if the health care provider would otherwise be eligible for payment.
(b)	For purposes of this section, 'health benefit plans' means accident and health insurance policies or certificates; nonprofit hospital or medical service corporation contracts; health, hospital, or medical service corporation plan contracts; health maintenance organization (HMO) subscriber contracts and other plans provided by managed care organizations; plans provided by a MEWA or plans provided by other benefit arrangements, to the extent permitted by ERISA; and the Teachers' and State Employees' Comprehensive Major Medical Plan."
Sec. 3.  Chapter 90 of the General Statutes is amended by adding a new Article 28 to read:
"ARTICLE 28.
"Medical Records.
"§ 90-410. Definitions.
As used in this Article:
(1)	'Health care provider' means any person who is licensed or certified to practice a health profession or occupation under this Chapter or Chapters 90B or 90C of the General Statutes, a health care facility licensed under Chapters 131E or 122C of the General Statutes, and a representative or agent of a health care provider.
(2)	'Medical records' means personal information that relates to an individual's physical or mental condition, medical history, or medical treatment, excluding X rays.
"§ 90-411. Record copy fee.
A health care provider may charge a reasonable fee to cover the costs incurred in searching, handling, copying, and mailing medical records to the patient or the patient's designated representative.  The maximum fee shall be fifty cents (50¢) per page, provided that the health care provider may impose a minimum fee of up to ten dollars ($10.00), inclusive of copying costs.  Nothing herein shall limit a reasonable professional fee charged by a physician for cognitive work in association with review of medical records in connection with any request for copies of a medical record or report."
Sec. 4. This act becomes effective January 1, 1994.