GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1993

S	3 

SENATE BILL 7
Insurance Committee Substitute Adopted 4/8/93
Third Edition Engrossed 4/27/93

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  G.S. 58-50-10 is repealed.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.