Health insurance billing codes.

WORKING DRAFT
2007
STATE OF
WYOMING
07LSO-0352

SENATE FILE
NO.
SF0129

Health insurance billing codes.

Sponsored by:
Senator(s) Meier and Representative(s) Millin

A BILL

for

AN ACT relating to health insurance; providing for the creation and regulation of a web site by the insurance department to post medical billing code information as specified; requiring posting of billing codes as specified; providing for an exception; granting rulemaking authority; requiring payment of wellness benefits without regard to billing code identification; and providing for an effective date.

Be It Enacted by the Legislature of the State of
Wyoming
:

Section 1.
W.S. 26
‑
15
‑
137
is
created to read:

26
‑
15
‑
137.

Publication of procedure billing codes.

(a)

The department shall develop and make available free of charge to the public, via the Internet, the World Wide Web or a similar proprietary or common carrier electronic system, a web site for the posting of billing code information relating to the medical claim procedure codes of each insurer or health maintenance organization that pays medical claims on behalf of its insureds or certificate holders in this state on a fee for service basis. The information posted shall be indexed for each insurer

by procedure name and alphanumerically by billing code, with an appropriate cross index. The web site shall permit the insurer to describe in footnotes the services included in each procedure or code. The web site shall also contain a section where the insurer may post contact information for further explanation of the posted information.

(b)

The department shall specify by rule and regulation the mandatory and optional information to be posted, the frequency of updates permitted and the format of the information to be supplied by insurers and health maintenance organizations.

(c)

Each insurer or health maintenance organization that pays medical claims on behalf of its insureds or certificate holders in this state on a fee for service basis shall provide the information described in subsection (a) of this section, and in department rules and regulations promulgated pursuant to this section, in the manner and at such times as prescribed by the department.

(d)

Upon approval of the commissioner, an insurer may comply with the requirements of subsection (a) of this section by posting on the department's web site a link to another web site that contains the same information as required by subsection (a) of this section and department rule and regulation.

Section 2.
W.S. 26
‑
18
‑
1
03
(b) is amended to read:

26
‑
18
‑
103. General requirements for policies.

(b)

As used in paragraph (a)(ix) of this section, "comprehensive adult wellness benefits" means benefits not subject to policy deductibles, which provide a minimum benefit equal to eighty percent (80%) of the reimbursement allowance under the private health benefit plan with a maximum of twenty percent (20%) coinsurance by the insured and which provide a benefit structure to the insured equal to a minimum of one hundred fifty dollars ($150.00) per insured adult per calendar year, or a benefit structure of similar actuarial value to the insured. In addition, the benefits shall at minimum provide for testing procedures and for the examination of adult policyholders and their spouses for breast cancer, prostate cancer, cervical cancer and diabetes.
The insurer under a policy covering comprehensive adult wellness benefits shall promptly pay a valid claim for a covered test or procedure if the claim is presented as required by the policy and the test or procedure is sufficiently described by the health care provider, without regard to the provider's identification of the correct billing code for the test or procedure.

Section 3.

This act is effective July 1, 2007.

(END)

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SF0129