CHAPTER 150. UNIFORM HEALTH INSURANCE
CLAIM FORM—STATEMENT OF POLICY

Sec.


150.1.    HCFA 1500 and UB 82 Health Insurance Claim Forms.
150.2.    Additional information requests.
150.3.    Exceptions.
150.4.    Electronic billing.
150.5.    Request for extension of time.

Source

   The provisions of this Chapter 150 adopted July 2, 1993, effective July 3, 1993, 23 Pa.B. 3133, unless otherwise noted.

§ 150.1. HCFA 1500 and UB 82 Health Insurance Claim Forms.

 Article XII of The Insurance Company Law of 1921 (40 P. S. § §  991.1201—991.1205) directs the Insurance Department to develop a uniform health insurance claim form. Effective November 1, 1993, the Department of Public Welfare’s health care coverage program and all insurers, as defined in section 1201 of The Insurance Company Law of 1921 (40 P. S. §  992.1201), shall accept from Pennsylvania health care providers the HCFA 1500 and UB 82 forms, or their successors, as required for use in the Federal Medicare Program, for services performed in this Commonwealth for which providers are required to submit a claim form for reimbursement.

§ 150.2. Additional information requests.

 As required by Article XII of The Insurance Company Law of 1921 (40 P. S. § §  991.1201—991.1205), the uniform health insurance claim form shall contain blank spaces for additional information requests. An insurer or the Department of Public Welfare may request Insurance Departmental approval of additional information to be printed in the blank spaces on the uniform health insurance claim form, and on subsequent pages, if necessary. The requests will be published in the Pennsylvania Bulletin for public comment. The Insurance Department will review the requests in accordance with the procedures under 2 Pa.C.S. (relating to administrative law and procedure). The requests will be deemed approved by the Insurance Department if not disapproved within 60 days after receipt of the request.

§ 150.3. Exceptions.

 (a)  The requirements of Article XII of The Insurance Company Law of 1921 (40 P. S. § §  991.1201—991.1205) do not extend to items such as logos, letterhead, color of paper or ink type.

 (b)  The requirements of Article XII of The Insurance Company Law of 1921 also do not extend to claims related to pharmaceutical services.

 (c)  In the case of vision, dental and supplemental major medical claims, utilization of the uniform health insurance claim form shall be at the discretion of the individual insurer.

§ 150.4. Electronic billing.

 When a health care provider and an insurer agree to submit and accept claims on an electronic basis, the agreement shall be deemed to constitute compliance with Article XII of The Insurance Company Law of 1921 (40 P. S. § §  991.1201—991.1205).

§ 150.5. Request for extension of time.

 The Insurance Department may consider a request from the Department of Public Welfare for an extension in meeting the implementation deadline under section 1202(b) of The Insurance Company Law of 1921 (40 P. S. §  991.1202(b)). A request by the Department of Public Welfare and the Insurance Department’s subsequent ruling will be published in the Pennsylvania Bulletin.



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