Public Act No. 19-155 Summary

• Contracting health organizations must provide providers internet access to fee schedules for CPT, CDT, and HCPCS codes applicable to their specialty, plus organizational policies and procedures regarding payments and appeals (effective January 1, 2020).

• Material fee schedule changes limited to once annually with 90 days' notice; providers may terminate with 60 days' notice or accept other specified changes with 30 days' notice for compliance, clinical protocols, or Medicare alignment.

• Contracting health organizations cannot cancel or reclaim payments for authorized claims more than 18 months after receipt of a clean claim, except for fraud, improper billing, duplicate payments, coordination of benefits, or primary payor issues.

• Prohibited contract clauses prevent organizations from requiring providers to disclose rates from competitors, charging lowest-rate pricing, or restricting provider contracting with other organizations (void for contracts entered after October 1, 2011, or by January 1, 2014).

• Dental insurers using provider networks must limit fee schedule adjustments to once annually with 90 days' notice disclosing percentage impact or effects on the provider's 20 most frequently performed procedures.