MO HB2477

Health benefit plans must respond to electronic predetermination requests from providers with accurate information on expected benefits coverage for specified procedures

Required response information includes: patient's expected payment (deductible, coinsurance, co-payment), provider payment amount, institution payment amount, and any fee schedule adjustments with policy explanations

Predetermination responses provided in good faith are non-binding estimates only and do not guarantee final benefit amounts

Requests and responses must use HIPAA-compliant standard electronic transactions (ASC X12 formats), with responses returned via the same transmission method as the request

Effective date: July 1, 2017