This bill amends Florida Statutes to make participation in the statewide provider and health plan claim dispute resolution program mandatory for both providers and health plans, eliminating the option to opt out. It introduces the definition of "denied prior authorization request," which encompasses situations where a health plan either disapproves a prior authorization request or fails to act within the required timeframe. The bill expands the dispute resolution program to include these denied requests and mandates that if a health plan is determined to be the nonprevailing party in such disputes, it must reimburse the provider for reasonable costs incurred in pursuing the claim.

Additionally, the bill revises payment methods between health insurers and healthcare providers, specifically prohibiting contracts from requiring credit card payments as the sole payment method. It allows for electronic funds transfers, with health insurers required to inform providers of any associated fees. The bill also ensures that health insurers cannot deny claims for procedures included in prior authorizations unless certain conditions are met, thereby enhancing protections for providers and patients. The new provisions will take effect on January 1, 2025, for dentists and January 1, 2027, for physicians, with the overall act set to commence on July 1, 2026.

Statutes affected:
S 1198 Filed: 408.7057, 409.967, 627.64194