The bill introduces the "Primary Care Administrative Fairness Act" as a new chapter in Title 27 of the General Laws concerning insurance. It establishes several key provisions aimed at improving the administrative processes for primary care providers. Specifically, it prohibits payers from requiring primary care providers to perform uncompensated referral coordination services, which include preparation of documentation, submission of prior authorizations, communication with specialists or insurers, tracking of approvals, and transmission of materials.

Additionally, the bill mandates that payers either eliminate prior authorization requirements for all primary care initiated referrals or reimburse primary care practices for the reasonable attributable costs of referral coordination services, which must be paid separately and unbundled from evaluation and management payments or capitated payments, including Medicare Advantage payments.

The act also ensures that laboratory services cannot be denied solely based on the specific diagnostic code submitted by the ordering physician, provided that the service is covered under any recognized ICD-10 code. Furthermore, it prohibits payers from requiring physicians or practices to resubmit claims, modify codes, or provide additional justification solely to satisfy the payer's internal coding preferences when the service is otherwise covered.

Any contract provisions that violate these stipulations will be deemed void and unenforceable. The enforcement of these provisions will be overseen by the office of the health insurance commissioner, which is tasked with requiring payers to update participating provider agreements by January 1, 2027, reviewing payer policies for compliance, voiding any inconsistent contract provisions, and publishing annual reports on referral volumes, reimbursements for referral coordination services, and laboratory claim denial rates starting January 1, 2028. The act is set to take effect on January 1.