MO SB1023

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

Predetermination responses must include: expected patient payment amounts (deductible, coinsurance, co-payment), provider payment amount, institution payment amount, and any payment adjustments from fee schedules with policy explanations

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

All predetermination requests and responses must use HIPAA-compliant standard electronic transactions (ASC X12 837I, 837P, or 835 formats), with responses returned via the same transmission method as the request

Effective date: July 1, 2017