The bill aims to enhance accountability among health insurers by amending several sections of Florida Statutes related to health plans and managed care. Key provisions include a requirement for health plans to participate in filed claim disputes, with penalties for non-compliance, and a mandate for timely payment to providers following agency orders. The Agency for Health Care Administration is tasked with notifying relevant entities when health plans fail to pay providers. Additionally, the bill introduces credentialing requirements for managed care plans, which must identify ownership interests and affiliations with various healthcare entities, and report this information to the agency and the Office of Insurance Regulation.

Further amendments include the stipulation that managed care contracts must include notifications to providers regarding coverage denials, and insurers are prohibited from denying claims for previously authorized services unless they notify both the insured and the provider of any changes in coverage status. The bill also removes a provision that made certain audit report results dispositive, thereby allowing for more flexibility in compliance assessments. Overall, the legislation seeks to improve transparency and accountability in the health insurance sector, ensuring that providers are paid promptly and that patients receive clear communication regarding their coverage.

Statutes affected:
H 1097 Filed: 409.973, 409.9855