Effective - 28 Aug 1992
374.184. Director to prescribe by rule uniform claim forms for reporting — consultation, hearing — contents of forms — companies may request additional information — effective date of regulations. — 1. The director of the department of commerce and insurance shall prescribe by rule, after due consultation with providers of health care or treatment and their respective licensing boards, accident and sickness insurers, health services corporations and health maintenance organizations, and after a public hearing, uniform claim forms for reporting by health care providers. Such prescribed forms shall include but need not be limited to information regarding the medical diagnosis, treatment and prognosis of the patient, together with the details of charges incident to the providing of such care, treatment or services, sufficient for the purpose of meeting the proof requirements of an accident and sickness insurance or hospital, medical or dental services contract. Such prescribed forms shall be based upon the UB-82 form, with respect to hospital claims, and the HCFA 1500 form, with respect to physician claims, as such forms are modified or amended from time to time by the National Uniform Billing Committee or the federal Health Care Financing Administration.
2. The adoption of any uniform claim forms by the director pursuant to this section shall not preclude an insurer, health services corporation, or health maintenance organization from requesting any necessary additional information in connection with a claims investigation from the claimant, provider of health care or treatment, or certifier of coverage. The provisions of this section shall not be deemed or construed to apply to electronic claims submission. Insurers and providers may by contract provide for modifications to the uniform billing document where both insurers and providers feel that such modifications streamline claims processing procedures relating to the claims of the insurer involved in such contract modification. However, a refusal by the provider to agree to modification of the uniform billing format shall not be used by the insurer as grounds for refusing to enter into a contract with the provider for reimbursement or payment for health services rendered to an insured of the insurer.
3. Rules adopted or promulgated pursuant to this act* shall be subject to notice and hearing as provided in chapter 536. The regulations so adopted shall specify an effective date, which shall not be less than one hundred eighty days after the date of adoption, after which no accident and sickness insurer, health services corporation or health maintenance organization shall require providers of health care or treatment to complete forms differing from those prescribed by the director pursuant to this section, and after which no health care provider shall submit claims except upon such prescribed forms; provided that the provisions of this section shall not preclude the use by any insurer, health services corporation or health maintenance organization of the UB-82 form or the HCFA 1500 form.
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(L. 1992 S.B. 796 § 13)
*"This act" (S.B. 796, 1992) contained numerous sections. Consult Disposition of Sections table for a definitive listing.
Structure Missouri Revised Statutes
Title XXIV - Business and Financial Institutions
Chapter 374 - Department of Commerce and Insurance
Section 374.005 - Department created, duties — definitions.
Section 374.007 - Statutory reference changes authorized.
Section 374.010 - Department — general powers.
Section 374.020 - Director — qualifications — appointment.
Section 374.030 - Director — oath — bond.
Section 374.040 - Director — duties — administrative hearing commission law not applicable.
Section 374.045 - Director authorized to make rules and regulations, procedure, this chapter.
Section 374.047 - Willful violation of state law, order — notice.
Section 374.050 - Seal of office — effect.
Section 374.051 - Refusal of license and nonrenewal, applicant may appeal, procedure.
Section 374.055 - Grievance procedure.
Section 374.056 - Rulemaking authority, delivery methods.
Section 374.057 - Filing of records and signatures authorized when in compliance with federal law.
Section 374.060 - Office location and hours.
Section 374.070 - Office and records, public — copies — records disposed of or destroyed, when.
Section 374.071 - Insurance records exempt from public disclosure — release permitted, when.
Section 374.075 - Divisions, director may establish.
Section 374.080 - Deputy director, appointment, powers — governor to appoint, when.
Section 374.085 - Division of consumer affairs, duties — legal adviser may assist.
Section 374.100 - Actuary — duties — fees.
Section 374.110 - Examiner — duties — assistants — fees.
Section 374.130 - Chief clerk, duties and powers.
Section 374.170 - Forms furnished companies.
Section 374.180 - Director to prepare report — publication — special reports.
Section 374.182 - Organization plan to be submitted — contents.
Section 374.185 - Uniformity of regulation, director to cooperate.
Section 374.190 - Investigation of companies.
Section 374.202 - Purpose of law — definitions.
Section 374.210 - False testimony — refusal to furnish information — penalties.
Section 374.215 - Failure to timely file report or statement, penalty.
Section 374.216 - False financial statements, filing of — penalty.
Section 374.217 - Covenant not to sue officers of insurer, prohibited — no force and effect.
Section 374.220 - Expenses, how paid.
Section 374.230 - Fees — paid to director.
Section 374.240 - Suit to recover fees — penalties.
Section 374.250 - Accounts of director.
Section 374.270 - Department may elect workers' compensation coverage — coverage, how provided.
Section 374.280 - Civil penalty or forfeiture ordered when, how enforced.
Section 374.284 - Health insurance advisory committee established, members, duties.
Section 374.285 - Expungement of certain disciplinary action records.
Section 374.300 - Financial institution defined.
Section 374.310 - Refusal to grant or renew insurance license, when.
Section 374.350 - Short title.
Section 374.351 - Intent of compact.
Section 374.400 - Definitions.
Section 374.405 - Reports of premiums and loss data required, when — director may review.
Section 374.415 - Product liability insurance reports required — when — contents.
Section 374.420 - Insurers not liable because of compliance.
Section 374.425 - Time for compliance may be waived or extended.
Section 374.450 - Definitions.
Section 374.455 - Premium and loss data, annual report — available to public.
Section 374.500 - Definitions.
Section 374.503 - Certificate required for utilization review agents, exceptions.
Section 374.505 - Application for certificate, content, form, fee.
Section 374.507 - Information may be required by department of commerce and insurance.
Section 374.510 - Minimum requirements for utilization review agents.
Section 374.515 - Rules and regulations authorized.
Section 374.695 - Citation of law.
Section 374.700 - Definitions.
Section 374.702 - License required, restrictions on practice.
Section 374.705 - Department, powers and duties — fees, how determined.
Section 374.710 - License required for bail bond agents, application, qualifications — exceptions.
Section 374.717 - Prohibited acts.
Section 374.720 - Examination, form, content — reexamination fee.
Section 374.730 - License, biannual renewal, fee.
Section 374.740 - Nonresident license requirements.
Section 374.750 - Refusal to issue or renew license — applicant's right to hearing.
Section 374.760 - Unsatisfied judgments, affidavit filed monthly, form — content.
Section 374.764 - Alleged violations and complaints, procedure.
Section 374.775 - Bonds of one thousand dollars or less — fee — additional fee — prohibited.
Section 374.783 - Surety recovery agents, license required — director to license, powers.
Section 374.785 - Apprehension of defendant, permitted where.
Section 374.786 - Renewal, procedure.
Section 374.787 - Complaint procedure.
Section 374.788 - Apprehension standards for breach of surety agreement or absconding.