58-3-171. Uniform claim forms.
(a) All claims submitted by health care providers to health benefit plans shall be submitted on a uniform form or format that shall be developed by the Department and approved by the Commissioner. Additional information beyond that contained on the uniform form or format may be collected subject to rules adopted by the Commissioner. This section applies to the submission of claims in writing and by electronic means.
(b) After consultation with the North Carolina Industrial Commission, the Commissioner may include workers' compensation insurance policies as "health benefit plans" for the purpose of administering the provisions of this section.
(c) For purposes of this section, "health benefit plans" means accident and health insurance policies or certificates; nonprofit hospital or medical service corporation contracts; health maintenance organization (HMO) subscriber contracts and other plans provided by managed-care organizations; plans provided by a MEWA or plans provided by other benefit arrangements, to the extent permitted by ERISA; the State Health Plan for Teachers and State Employees and any optional plans or programs operating under Part 2 of Article 3 of Chapter 135 of the General Statutes; and medical payment coverages under homeowners and automobile insurance policies. (1993, c. 529, s. 4.2; 2007-298, s. 8.2; 2007-323, s. 28.22A(o); 2007-345, s. 12.)
Structure North Carolina General Statutes
North Carolina General Statutes
Article 3 - General Regulations for Insurance.
§ 58-3-1 - State law governs insurance contracts.
§ 58-3-5 - No insurance contracts except under Articles 1 through 64 of this Chapter.
§ 58-3-6 - Charitable gift annuities.
§ 58-3-7 - Certain accountable care organizations not subject to this Chapter.
§ 58-3-8 - Medical direct primary care agreements not subject to this Chapter.
§ 58-3-10 - Statements in application not warranties.
§ 58-3-15 - Additional or coinsurance clause.
§ 58-3-20 - Group plans other than life, annuity or accident and health.
§ 58-3-25 - Discriminatory practices prohibited.
§ 58-3-30 - Meaning of terms "accident", "accidental injury", and "accidental means".
§ 58-3-33 - Insurer conditionally required to provide information.
§ 58-3-35 - Stipulations as to jurisdiction and limitation of actions.
§ 58-3-40 - Proof of loss forms required to be furnished.
§ 58-3-45 - Insurance as security for a loan by the company.
§ 58-3-50 - Companies must do business in own name; emblems, insignias, etc.
§ 58-3-55 - Must not pay death benefits in services.
§ 58-3-60 - Publication of assets and liabilities; penalty for failure.
§ 58-3-65 - Publication of financial information.
§ 58-3-71 - Unearned premium reserves.
§ 58-3-72 - Premium deficiency reserves.
§ 58-3-75 - Loss and loss expense reserves of fire and marine insurance companies.
§ 58-3-81 - Loss and loss expense reserves of casualty insurance and surety companies.
§ 58-3-100 - Insurance company licensing provisions.
§ 58-3-105 - Limitation of risk.
§ 58-3-110 - Limitation of liability assumed.
§ 58-3-115 - Twisting with respect to insurance policies; penalties.
§ 58-3-120 - Discrimination forbidden.
§ 58-3-121 - Discrimination against coverage of certain bones and joints prohibited.
§ 58-3-135 - Certain insurance activities by lenders with customers prohibited.
§ 58-3-137 - Prohibition on provisions relating to replacement cost estimators.
§ 58-3-140 - Temporary contracts of insurance permitted.
§ 58-3-145 - Solicitation, negotiation or payment of premiums on insurance policies.
§ 58-3-147 - Credit card guaranty or collateral prohibited.
§ 58-3-149 - Certificates of insurance.
§ 58-3-150 - Forms to be approved by Commissioner.
§ 58-3-151 - Deemer provisions.
§ 58-3-152 - Excess liability policies; uninsured and underinsured motorist coverages.
§ 58-3-155 - Business transacted with insurer-controlled brokers.
§ 58-3-160 - Sale of company or major reorganization; license to be restricted.
§ 58-3-165 - Business transacted with producer-controlled property or casualty insurers.
§ 58-3-167 - Applicability of acts of the General Assembly to health benefit plans.
§ 58-3-168 - Coverage for postmastectomy inpatient care.
§ 58-3-169 - Required coverage for minimum hospital stay following birth.
§ 58-3-170 - Requirements for maternity coverage.
§ 58-3-171 - Uniform claim forms.
§ 58-3-172 - Notice of claim denied.
§ 58-3-175 - Direct payment to government agencies.
§ 58-3-176 - Treatment discussions not limited.
§ 58-3-177 - Uniform prescription drug identification cards.
§ 58-3-179 - Coverage for colorectal cancer screening.
§ 58-3-180 - Motor vehicle repairs; selection by claimant.
§ 58-3-181 - Synchronization of prescription refills.
§ 58-3-185 - Lien created for payment of past-due child support obligations.
§ 58-3-190 - Coverage required for emergency care.
§ 58-3-191 - Managed care reporting and disclosure requirements.
§ 58-3-192 - Coverage for autism spectrum disorder.
§ 58-3-200 - Miscellaneous insurance and managed care coverage and network provisions.
§ 58-3-215 - Genetic information in health insurance.
§ 58-3-220 - Mental illness benefits coverage.
§ 58-3-221 - Access to nonformulary and restricted access prescription drugs.
§ 58-3-223 - Managed care access to specialist care.
§ 58-3-225 - Prompt claim payments under health benefit plans.
§ 58-3-227 - Health plans fee schedules.
§ 58-3-228 - Coverage for extra prescriptions during a state of emergency or disaster.
§ 58-3-230 - Uniform provider credentialing.
§ 58-3-231 - Payment under locum tenens arrangements.
§ 58-3-235 - Selection of specialist as primary care provider.
§ 58-3-240 - Direct access to pediatrician for minors.
§ 58-3-245 - Provider directories; cost tools for insured.
§ 58-3-247 - Insurance identification card.
§ 58-3-250 - Payment obligations for covered services.
§ 58-3-255 - Coverage of clinical trials.
§ 58-3-256 - Coverage related to organ transplants.
§ 58-3-260 - Insurance coverage for newborn hearing screening mandated.
§ 58-3-265 - Prohibition on managed care provider incentives.
§ 58-3-270 - Coverage for surveillance tests for women at risk for ovarian cancer.
§ 58-3-275 - Closure of a block of business.
§ 58-3-280 - Coverage for the diagnosis and treatment of lymphedema.
§ 58-3-285 - Coverage for hearing aids.
§ 58-3-290 - Nondependent child coverage defined; open enrollment.
§ 58-3-300 - Health insurance issuers subject to certain requirements of federal law.