An Act To Improve the Quality of Health Care in Maine
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 22 MRSA §8708, sub-§6-B is enacted to read:
6-B. Standardized submission of claims forms. All commercial health care insurance claims for all professional services provided by an allopathic or osteopathic physician licensed in this State who works in an office setting or is employed by a hospital, an affiliate of a hospital or other health care facility or whose claims are billed by the hospital system or facility where the services are performed must be submitted to payors using the standard federal professional paper claim form, CMS 1500, or its successor and the American National Standards Institute Accredited Standards Committee X12N 837 electronic submittal standards for noninstitutional providers and suppliers. The claims form must contain an identification code for the rendering physician. For purposes of this section, "office setting" means a location where the physician routinely provides health examinations, diagnoses and treatment of illness or injury on an ambulatory basis, whether or not the office is physically located within a facility.
summary
This bill requires that all commercial health insurance claims for all professional services provided by physicians who are employed by hospital systems or affiliates of hospital systems and other health care facilities be submitted on the standard federal professional paper claim form, CMS 1500, used by noninstitutional providers and suppliers. This requirement ensures that the Department of Health and Human Services, the Maine Quality Forum and the Maine Health Data Organization are able to accurately attribute particular health care services to individual physicians.