Missouri § 376.1400 - Explanation of benefits, standardized information used, contents, when.

§ 376.1400. Explanation of benefits, standardized information used, contents, when.

1.  Every health insurance carrier offering policies of insurance in this state shall use standardized information for the explanation of benefits given to the health care provider whenever a claim is paid or denied.  As used in this section, the term "health insurance carrier" shall have the meaning given to "health carrier" in section 376.1350.  Nothing in this section shall apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, short-term major medical policies of six months or less duration, other limited benefit health insurance policies.

2.  The standardized information shall contain the following:

(1)  The name of the insured;

(2)  The insured's identification number;

(3)  The date of service;

(4)  Amount of charge;

(5)  Explanation for any denial;

(6)  The amount paid;

(7)  The patient's full name;

(8)  The name and address of the insurer; and

(9)  The phone number to contact for questions on explanation of benefits.

3.  All health insurance carriers shall use the standard explanation of benefits information after January 1, 2002.

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(L. 1999 H.B. 191)

---- end of effective  28 Aug 1999 ----

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