The proposed legislation, General Assembly Raised Bill No. 5377, aims to amend the current regulations regarding health care provider payments and billing requirements. Notably, it reduces the time frame in which health organizations can cancel, deny, or demand the return of payments for authorized services from eighteen months to fifteen months after the receipt of a clean claim. The bill also introduces several conditions under which a health organization may still demand payment, including instances of fraud or improper billing. Additionally, it mandates that health organizations provide at least thirty days' notice to providers before taking such actions, and establishes an electronic appeal process for providers to contest these demands.

Furthermore, the bill introduces new requirements for hospital-based facilities located off-site from hospital campuses. Starting January 1, 2027, these facilities must include their national provider identifier and federal tax identification number on all claims for reimbursement. Health carriers will not be obligated to reimburse claims that do not meet these requirements, and facilities that fail to comply cannot hold covered persons liable for payment. The Insurance Commissioner is also granted the authority to adopt regulations to implement these provisions. Overall, the bill seeks to streamline the payment process and enhance transparency in health care billing practices.