summary
Introduced
01/06/2026
01/06/2026
In Committee
01/12/2026
01/12/2026
Crossed Over
Passed
Dead
03/13/2026
03/13/2026
Introduced Session
2026 Regular Session
Bill Summary
An act relating to insurance claims payments to health care providers; amending s. 408.7057, F.S.; defining the terms "claim dispute" and "denied prior authorization request"; requiring the Agency for Health Care Administration to establish a program to assist health care providers and health plans in resolving claims of denied prior authorization requests; providing that the program is mandatory; revising the list of claims that are not reviewed by the program; prohibiting respondents from avoiding default by refusing to participate in the review process; requiring health plans to reimburse health care providers' costs in bringing claims under certain circumstances; requiring the agency to adopt rules; amending ss. 627.6131 and 641.315, F.S.; prohibiting contracts between health care providers and health insurers and health maintenance organizations, respectively, from specifying credit card payments to providers as the only acceptable method for payments; authorizing use of electronic funds transfers by health insurers and health maintenance organizations, respectively, for payments to providers under certain circumstances; providing notification requirements; prohibiting health insurers and health maintenance organizations, respectively, from charging fees for automated clearinghouse transfers as claims payments to providers; providing an exception; providing applicability; prohibiting health insurers and health maintenance organizations, respectively, from denying claims subsequently submitted by providers for procedures that were included in prior authorizations; providing exceptions; providing applicability; defining the term "provider"; providing an effective date.
AI Summary
This bill establishes a mandatory program administered by the Agency for Health Care Administration (AHCA) to help healthcare providers and health plans resolve disputes over denied prior authorization requests, which are determinations by a health plan that a provider's request for a healthcare service, supply, or medication has been denied, not acted upon in a timely manner, or approved with overly restrictive conditions. The program will not review claims related to interest payments, those below certain monetary thresholds, Medicare appeals, claims against non-state regulated plans, Medicaid fair hearings, or claims already in litigation. Respondents in these disputes cannot avoid a default judgment by refusing to participate in the review process, and if a health plan is found to be the nonprevailing party in a denied prior authorization dispute, they must reimburse the provider for reasonable costs incurred in bringing the claim. Additionally, the bill prohibits contracts between health insurers or health maintenance organizations (HMOs) and providers from exclusively requiring credit card payments, mandates notification and consent for electronic funds transfers (EFTs) like virtual credit cards, and prevents insurers/HMOs from charging fees for Automated Clearing House (ACH) transfers unless the provider agrees. It also prohibits health insurers and HMOs from denying claims for procedures that were previously authorized, with specific exceptions, and defines "provider" to mean a "health care provider" as defined in state law.
Committee Categories
Health and Social Services
Sponsors (1)
Last Action
Died in Health Care Facilities & Systems Subcommittee (on 03/13/2026)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.flsenate.gov/Session/Bill/2026/1023 |
| BillText | https://www.flsenate.gov/Session/Bill/2026/1023/BillText/Filed/PDF |
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