Bill > S1198

Introduced Session

An act relating to health insurance claims; amending s. 408.7057, F.S.; defining the term “denied prior authorization request”; expanding the scope of the statewide provider and health plan claim dispute resolution program to include resolution of denied prior authorization requests; providing that participation in the program is mandatory and prohibiting providers and health plans from opting out of the claim dispute resolution process; revising circumstances under which a claim dispute is exempt from the program’s claim dispute resolution process; providing that respondents in claim disputes may not avoid imposition of a default by declining to participate in the claim dispute resolution process; providing for reimbursement of reasonable costs to providers if the health plan is determined to be the nonprevailing party in a claim dispute involving a denied prior authorization request; requiring the Agency for Health Care Administration to adopt certain rules; amending ss. 627.6131 and 641.315, F.S.; prohibiting contracts between certain physicians and health insurers and health maintenance organizations, respectively, from specifying credit card payments to physicians as the only acceptable method for payments; authorizing use of electronic funds transfers by health insurers and health maintenance organizations, respectively, for payments to physicians 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 physicians; providing an exception; providing applicability; prohibiting health insurers and health maintenance organizations, respectively, from denying claims subsequently submitted by physicians for procedures that were included in prior authorizations; providing exceptions; providing applicability; amending ss. 409.967 and 627.64194, F.S.; conforming provisions to changes made by the act; providing an effective date.

AI Summary

Ralph Massullo (R)*, 

Died in Banking and Insurance (on 03/13/2026)

Official Document