No. CS/SB 1082
Filed under Healthcare.
Statewide Provider and Health Plan Claim Dispute Resolution Program; Specifying additional circumstances under which a disputed claim is not subject to review under the statewide provider and health plan claim dispute resolution program, etc.
Plain English Summary
AI-GENERATEDAdds two new categories of disputed claims that Florida's statewide provider and health plan claim dispute resolution program will not review: emergency-services claims and out-of-network-provider claims that qualify for the federal independent dispute resolution process.
Applies only when the claim has been submitted and meets the criteria for resolution through the federal process, so a claim not eligible for federal review still goes through the state program as before.
Covers emergency services under both Florida's emergency-access statute and the federal Emergency Medical Treatment and Labor Act, keeping those disputes out of the state program when federal review applies instead.
AIA disputed claim tied to emergency services under Florida's emergency-access law or the federal Emergency Medical Treatment and Labor Act is excluded from the state dispute-resolution program if it has been submitted for, and meets the criteria for, the federal independent dispute resolution process instead.
AIA disputed claim involving an out-of-network provider is likewise excluded from the state dispute-resolution program once it has been submitted for, and meets the criteria for, resolution through the federal independent dispute resolution process.