SENATE BILL REPORT

                                   ESB 6037

                      AS PASSED SENATE, FEBRUARY 13, 1992

Brief Description:  Requiring a uniform health care insurance claim form.

SPONSORS: Senators West, Rinehart, Rasmussen and Johnson

SENATE COMMITTEE ON HEALTH & LONG‑TERM CARE

Majority Report:  Do pass as amended. 

      Signed by Senators West, Chairman; L. Smith, Vice Chairman; Amondson, Newhouse, Niemi, and Wojahn.

Staff:  Martin Lovinger (786‑7443)

Hearing Dates: January 22, 1992; January 28, 1992

BACKGROUND:

Several hundred health care service contractors, health maintenance organizations, and disability insurance companies, in addition to several government agencies, provide hospital and other medical services in Washington.  Many of these providers use different forms, often requiring similar or identical information.  Observers of health care financing structures have suggested that significant administrative cost reductions might be possible if the number of different billing forms used could be reduced. 

SUMMARY:

All private health insurance carriers in Washington have to use the HCFA 1500 form, or its successor, or the UB 82 form, or its successor, after January 1, 1994.  The state agencies that pay for health care have to adopt those forms by July 1, 1994.

Exempt from the requirements to use those two forms for billing purposes are pharmacists, dentists, home health/nursing services, eyeglasses, transportation or vocational services.

The basic health plan administrator, the Secretary of Department of Social and Health Services, the Health Care Authority Administrator and the Director of Labor and Industries have to develop jointly by January 1, 1993 forms to cover billing for the services exempt from the requirement to use the HCFA 1500 or UB 82 form.  These must be used by private insurance carriers after January 1, 1994 and by the state agencies that pay for health care services after July 1, 1994.

Appropriation:  none

Revenue:  none

Fiscal Note:  available

TESTIMONY FOR:

Intent is good but most private carriers already use the HCFA 1500 and UB 82 as standard forms.  Requiring the public sector to use the standard forms will achieve the standardization goal of the bill.

TESTIMONY AGAINST:

Use current standard forms instead of involving the Insurance Commissioner in designing a new uniform claim form.  Bill should require users to use standard form as well as providers.

TESTIFIED:  Mel Sorenson, Washington Physician Service and Blue Cross; Len Eddinger, Washington State Medical Assn.; Susie Tracy, Washington State Medical Group Management Assn.; Dave Rodgers, Office of the Insurance Commissioner