District of Columbia § 31-3201 Standardized uniform health insurance claims forms.

District of Columbia Statutes

§ 31-3201 — Standardized uniform health insurance claims forms.

District of Columbia·Title 31 Insurance and Securities.·Ch. 32 Health Insurance Forms.·Subch. I Uniform Claims Forms.

(a)The HCFA 1500 and UB 92 claims forms, or their successor forms as they may be amended from time to time, shall serve as the official health insurance claims forms of the District of Columbia for hospitals and other medical providers and governmental agencies, and such forms shall be used and exclusively accepted by all insurers, including health maintenance organizations and other forms of managed care, transacting health insurance, providing medical insurance through a personal automobile policy, workers’ compensation, or otherwise providing coverage for medical services, and by all hospitals, medical providers, and government agencies in the District of Columbia that require insurance claim forms for their records.

(b)The claims forms specified in subsection (a) of this section may

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(a) The HCFA 1500 and UB 92 claims forms, or their successor forms as they may be amended from time to time, shall serve as the official health insurance claims forms of the District of Columbia for hospitals and other medical providers and governmental agencies, and such forms shall be used and exclusively accepted by all insurers, including health maintenance organizations and other forms of managed care, transacting health insurance, providing medical insurance through a personal automobile policy, workers’ compensation, or otherwise providing coverage for medical services, and by all hospitals, medical providers, and government agencies in the District of Columbia that require insurance claim forms for their records.

(b) The claims forms specified in subsection (a) of this section may be modified as necessary to accommodate the transmission and administration of claims by electronic means.

(1) No later than January 1, 2024, a utilization review entity shall accept and respond to prior authorization requests under the pharmacy benefit through a secure electronic transmission using the NCPDP SCRIPT Standard ePA transactions, which shall not include facsimile, proprietary payer portals, electronic forms, or any other technology not directly integrated with a physician's electronic health record or electronic prescribing system.

(2) For the purposes of this subsection, the term:

(A) "NCPDP SCRIPT Standard ePA" means the National Council for Prescription Drug Programs SCRIPT Standard Version 2013101, or the most recent standard adopted by the United States Department of Health and Human Services.

(B) "Prior authorization" shall have the same meaning as provided in § 31-3875.01(7) .

(C) "Utilization review entity" shall have the same meaning as provided in § 31-3875.01(10) .

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