ID H0180

Health carriers offering qualified health plans through exchanges must provide health care providers a mechanism to verify whether a patient has paid their premium and the payment period covered

The verification mechanism may be provided through online portals, telephone, or other electronic means and must provide current information with documentation capability

Health care providers are entitled to rely on insurance status information provided by health carriers and cannot be denied reimbursement if payment is confirmed, except when the payment instrument is dishonored or premium is not indefeasibly paid

Addresses the grace period under the Affordable Care Act where policies cannot be canceled for 90 days despite nonpayment, preventing providers from being unable to collect for services rendered during that period

Effective January 1, 2016