SENATE HEALTH COMMITTEE

 

STATEMENT TO

 

SENATE, No. 47

 

with committee amendments

 

STATE OF NEW JERSEY

 

DATED: FEBRUARY 22, 1996

 

      The Senate Health Committee reports favorably Senate Bill No. 47 with committee amendments.

      As amended by committee, this bill provides for the resolution of routine billing disputes between insurers and health care providers without unnecessarily involving the insured. It requires hospital, medical and health service corporations, commercial health insurers, health maintenance organizations, dental plan organizations and dental service corporations to adopt and implement, after approval by the Commissioner of Insurance, a procedure which shall be used to resolve billing and payment disputes between the provider and the payer which result from lost or incomplete health care claim forms or electronic submissions, or involve a request for additional explanation as to services or treatment rendered by a health care provider. The bill requires direct communication between the provider and the insurer and also provides that the covered individual shall not be required to take any action to rectify the problem, other than verify that the services or treatment were received. The bill also requires that the procedure include an appeal process whereby the insurer, the provider or the covered individual may request an independent review of the initial resolution of the dispute by an arbitrator or independent review organization, agreed upon by the parties to the appeal. The bill provides that the decision of the arbitrator or review organization, as appropriate, shall be binding on the provider and carrier.

      This bill is part of a legislative package designed to effectuate the recommendations of the Healthcare Information Networks and Technologies (HINT) report to the Legislature under the joint auspices of Thomas Edison State College and the New Jersey Institute of Technology.

      The committee amended the bill to add the provision that the decision of the arbitrator or review organization is binding. Other amendments include dental plan organizations and dental service corporations under the provisions of the bill. Amendments also direct the Commissioner of Insurance to adopt regulations which include procedures to resolve disputes between carriers and covered individuals.