AMCNO Supports Legislation to Address Health Insurer Issues - SB 136 – We need your help on this important legislation that will impact your practice

This legislation will address four areas: prior authorization, timely payment, health insurer retrospective audits and contract fairness. The legislation would ensure that prior authorization requirements or restrictions are listed on the health insurer’s Web site; allow providers and patients to obtain PA authorizations through a web-based system; ensure that a new or future PA requirement is disclosed at least 60 days prior to the new requirement being implemented; guarantee that once a PA has been approved, the insurer will not retroactively deny coverage for the approved service and require insurers to disclose on their web sites statistics regarding PA approvals and denials. Timely payment issues are also addressed in the legislation. The draft legislation updates Ohio’s prompt pay law by requiring insurers and third party payers to process and pay claims in 15 days rather than 30 days.  

Health insurer retrospective audits are also addressed in the legislation – with the intent to update Ohio’s retrospective audit law to continue permitting take-backs but subject to the following guidelines – take-backs may occur up to 6 months after a payment is made or if the insurer requires the physician to submit claims for a period less than 6 months, then the take-back period will equal the time period to submit the claim. SB 136 would also prohibit unilateral contract amendments between insurers and physicians. The AMCNO will be involved in the debate on this legislation going forward offering our comments and strong support. 

The insurance companies are going to fight strongly against this legislation, which is why we are asking for help from our members and their practice administrators. The AMCNO and the state medical association are collecting this information in order to provide testimony on these issues as this bill is debated in the legislature. Please take a moment to go to this link and answer a few questions about take backs and prior authorizations that occur in your practice or practice setting. To complete this important survey and help the AMCNO provide examples in our testimony on this legislation go to https://www.surveymonkey.com/s/Support-SB136