1. A provider submitting a health claim in this state shall file the claim electronically and use a standardized electronic transaction submission format as provided in this section. The electronic transaction submission format shall use the American national standards institute form for data submission and reporting to the data repository. A payor offering health care coverage in the state shall accept electronic transaction submissions, provide remittance, and transmit eligibility electronically as provided by the board. This section requires, to the extent permitted under federal law, that a self-insured plan providing health care coverage in this state shall, on its own or through a third-party administrator or other third party, accept electronic transaction submissions, provide remittance, and transmit eligibility electronically as provided by the board. A transaction network shall have the ability to accept all transactions processed electronically through the system and transmit such transaction data to the appropriate network or payor, interface with other networks or payors, provide electronic eligibility for all payors, and provide for electronic remittance for claims and concurrently transmit data to the data repository.
2. The board shall review annually all transaction networks and their effectiveness, and provide for additional electronic filing requirements as necessary and feasible.
3. The system shall use identification numbers as follows:
a. A patient identification number shall be the individual's social security number, or, upon request of the patient, a random identification number.
b. A provider identification number system shall be established by the board including the unique physician identification number, the Medicare provider number, and other identifying numbers as provided by the board for providers who do not have a unique physician identification number or Medicare provider number.
c. Such other identification numbers as determined by the board to be necessary to assure efficient and accurate transmittal and receipt of data through the system.
4. The system shall contain a data repository consistent with section 144C.3 which shall maintain claims information and other information as determined by the board.
5. A person shall not engage in any transaction between health care providers, payors, and the data repository unless certified by the board.
94 Acts, ch 1033, §8
Previous Section 144C.6
Next Section 144C.8
© 1999 Cornell College and League of Women Voters of Iowa
Comments about this site or page?
webmaster@legis.iowa.gov.
Please remember that the person listed above does not vote on bills. Direct all comments concerning legislation to State Legislators.
Last update: Thu Mar 18 15:00:31 CST 1999
URL: /DOCS/IACODE/1999/144C/7.html
jhf