House Bill 1023 amends Florida Statutes to improve the resolution process for insurance claims disputes between health care providers and health plans, particularly focusing on denied prior authorization requests. The bill establishes a mandatory program through the Agency for Health Care Administration to assist in resolving these disputes, defining key terms such as "claim dispute" and outlining submission procedures, documentation requirements, and timelines. It also prohibits health plans from evading default by refusing to participate in the review process and mandates reimbursement of providers' costs in certain situations.

Additionally, the bill revises existing laws regarding payment methods for health care services, ensuring that contracts cannot specify credit card payments as the only acceptable method. It allows for electronic funds transfers and requires health insurers to inform providers of any associated fees. The bill clarifies that health maintenance organizations cannot deny claims for procedures included in prior authorizations unless specific conditions are met, such as changes in patient eligibility or documentation issues. Key changes include the insertion of the term "provider" to encompass a broader range of healthcare professionals and the removal of references to "dental insurers," replacing them with "health maintenance organizations." The provisions will apply to contracts delivered, issued, or renewed on or after January 1, 2025, for dentists and January 1, 2027, for other providers, with the act set to take effect on July 1, 2026.

Statutes affected:
H 1023 Filed: 408.7057