| All health maintenance organizations providing payment or |
reimbursement for diagnosis or treatment of a condition or a |
complaint by a licensed health care practitioner must accept the |
current standardized claim form for professional services |
approved by the Federal Government and submitted electronically. |
All health maintenance organizations providing payment or |
reimbursement for diagnosis or treatment of a condition or a |
complaint by a licensed hospital must accept the current |
standardized claim form for professional or facility services, as |
applicable, approved by the Federal Government and submitted |
electronically. A health maintenance organization may not be |
required to accept a claim submitted on a form other than the |
applicable form specified in this section and may not be required |
to accept a claim that is not submitted electronically, except |
from a health care practitioner who is exempt pursuant to Title |
24, section 2985. All services provided by a health care |
practitioner in an office setting must be submitted on the |
standardized federal form used by noninstitutional providers and |
suppliers.__Services in a nonoffice setting may be billed as |
negotiated between the health maintenance organization and health |
care practitioner. For purposes of this section, "office setting" |
means a location where the health care practitioner routinely |
provides health examinations, diagnosis and treatment of illness |
or injury on an ambulatory basis whether or not the office is |
physically located within a facility. |