A BILL TO BE ENTITLED
AN ACT to apply disclosure and notification requirements related to insurer fee schedules, claims submission, and reimbursement policies to stand alone dental insurance.
The General Assembly of North Carolina enacts:
SECTION 1.  G.S. 58‑3‑227(a) reads as rewritten:
"§ 58‑3‑227.  Health plans fee schedules.
(a)	Definitions. – As used in this section, the following terms mean:
...
(4)	Insurer. – An entity that writes a health benefit plan and that is an insurance company subject to this Chapter, a service corporation under Article 65 of this Chapter, a health maintenance organization under Article 67 of this Chapter, or a multiple employer welfare arrangement under Article 49 of this Chapter.
(5)	Reimbursement policy. – Information relating to payment of providers and facilities including policies on the following:
a.	Claims bundling and other claims editing processes.
b.	Recognition or nonrecognition of CPT code modifiers.
c.	Downcoding of services or procedures.
d.	The definition of global surgery periods.
e.	Multiple surgical procedures.
f.	Payment based on the relationship of procedure code to diagnosis code.
(6)	Schedule of fees. – CPT, HCPCS, ICD‑9‑CM codes, ICD‑10‑CM codes, ASA codes, modifiers, and other applicable codes for the procedures billed for that class of provider."
SECTION 2.  This act becomes effective July 1, 2017.