No. HB 1023
Filed under Insurance.
Insurance Claims Payments to Health Care Providers; Requires AHCA to establish program to assist health care providers & health plans in resolving claims of denied prior authorization requests; provides that program is mandatory; revises list of claims that are not reviewed by program; prohibits respondents from avoiding default by refusing to participate in review process; prohibits contracts between health care providers & health insurers & HMOs from specifying credit card payments to providers as only acceptable method for payments; authorizes use of electronic funds transfers by health insurers & HMOs for payments to providers; provides notification requirements; prohibits health insurers & HMOs from charging fees for automated clearinghouse transfers as claims payments to providers; prohibits health insurers & HMOs from denying claims subsequently submitted by providers for procedures that were included in prior authorizations; provides exceptions.
Plain English Summary
AI-GENERATEDA statewide dispute-resolution program at the state health care agency becomes mandatory: providers and health plans can no longer opt out. Disputes over denied, delayed, or overly restricted prior authorizations are now explicitly covered.
Health insurers and HMOs can no longer force any health care provider -- not just dentists -- into credit-card-only payment, and they cannot deny a claim for a procedure that was already pre-authorized except in narrow, listed situations.
When a health plan loses a prior-authorization dispute, it must now pay the provider's reasonable costs of bringing the claim. The new protections for providers other than dentists apply only to contracts renewed on or after January 1, 2027.
Health plans also lose an escape route: only a lawsuit already filed before a claim reaches review can exclude it, and refusing to participate in a review no longer avoids a default finding.
AIThe program's dispute definition now expressly covers prior authorization requests that are denied outright, left unanswered past the legal deadline, or approved with conditions so restrictive the service cannot actually be delivered as ordered.
AIProviders and health plans no longer have the option to sit out the dispute-resolution process; participation becomes a legal requirement rather than a voluntary choice.
AIWhen a claim dispute over a denied prior authorization goes against the health plan, the plan must now reimburse the provider's reasonable costs of bringing the claim, including filing fees and administrative costs the agency assessed.
AIContracts between health insurers or HMOs and any health care provider -- not just dentists -- can no longer require credit card as the only payment method, must get consent before using electronic funds transfer, and cannot charge a fee just to send an automated clearinghouse payment.
AIHealth insurers and HMOs cannot deny a claim for a procedure that was specifically included in a prior authorization -- a protection that used to cover only dentists -- unless a listed exception like fraud, ineligibility, or another payor's responsibility applies.
AIPreviously any claim tied to a pending court case was excluded from review, letting a party file suit to escape the process. Now only a lawsuit already filed over that specific claim, before it reaches the resolution organization, qualifies for exclusion.
AIA health plan or provider that simply declines to take part in the review process can no longer escape a default finding that way; refusing to participate is not a valid way to avoid default.