August 04, 2017

Florida Updates Claim Dispute Resolution Rule

A final rule covering claim dispute resolution for Florida’s balance billing law will go into effect on August 10.

Florida’s Agency for Health Care Administration published the final rule “Statewide Provider and Health Plan Claim Dispute Resolution Program” (59A-12.030) to reflect changes of enacted through House Bill 221 from the 2016 legislative session.

Gov. Rick Scott signed HB 221 on April 14, 2016, prior to its July 1, 2016, effective date. The law prohibits out-of-network providers from balance billing Preferred Provider Organization (PPO) or Exclusive Provider Organization (EPO) members for emergency services or non-emergency services when the non-emergency services are provided in a network hospital and the patient had no ability to select an in-network provider.

The law also established new standards for determining provider reimbursement. The Agency for Health Care Administration was tasked to establish rules for additional requirements relating to a resolution organization's process for considering certain claim disputes between providers and health plans in a specified dispute resolution program.