H1475: Health Care Services

Legislative Summary

Provides requirements related to utilization review entities authorization process for accepting electronic prior authorization; provides requirements related to payment adjudicators; authorizes OIR to investigate & take appropriate actions; authorizes provider to bring private cause of action; revises requirements of insurer contracts; revises requirements for health insurers submitting claims electronically & nonelectronically; removes prohibition against waiving, voiding, or nullifying certain provisions by contract; prohibits health insurer from retrospectively denying claim; revises procedures for investigation of claims of improper billing; prohibits insurer from requiring information from provider before provision of emergency services & care.