Sec. 10. (a) A health insurance plan may not require a dental provider to accept payment under the health insurance plan by virtual claim payment.

     (b) Before an initial payment to a dental provider using an electronic funds transfer payment, including a virtual claim payment, or before modifying the method of payment, a health insurer or contracted vendor of a health insurer shall:

Terms Used In Indiana Code 27-4-10-10

  • Automated Clearing House Network payment: means a payment made under National Automated Clearing House Association standards adopted in 45 C. See Indiana Code 27-4-10-1
  • Contract: A legal written agreement that becomes binding when signed.
  • dental provider: means :

    Indiana Code 27-4-10-3

  • Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) Source: OCC
  • electronic funds transfer payment: includes a payment by any method of electronic funds transfer other than an Automated Clearing House Network payment. See Indiana Code 27-4-10-4
  • health insurance plan: means :

    Indiana Code 27-4-10-5

  • health insurer: means an entity or person that issues a health insurance plan. See Indiana Code 27-4-10-6
  • provider billing agent: means a person or entity that contracts with a dental provider to provide billing services for the dental provider, including:

    Indiana Code 27-4-10-8

  • virtual claim payment: means a type of electronic funds transfer in which:

    Indiana Code 27-4-10-9

(1) notify the dental provider of any fees associated with the electronic funds transfer payment other than the fees imposed by the dental provider’s financial institution; and

(2) concerning a virtual claim payment, advise the dental provider of the methods of payment available under the health insurance plan and provide clear instructions to the dental provider as to how to select an alternate payment method.

     (c) A health insurer or contracted vendor of a health insurer may not charge a fee to a dental provider solely for transmitting an Automated Clearing House Network payment to the dental provider, unless the dental provider has consented to the fee. A provider billing agent may charge a reasonable fee to a dental provider for transmitting an Automated Clearing House Network payment as part of a fee charged by the provider billing agent for transaction management, data management, portal services, and other value added services in addition to the payment transmission that are provided by the provider billing agent to the dental provider.

     (d) The provisions of this section may not be waived by contract, and any contractual clause that conflicts with the provisions of this section or that purports to waive any requirement of this section is void.

     (e) Violation of this section is an unfair or deceptive act or practice in the business of insurance that is subject to enforcement by the commissioner under IC 27-4-1.

As added by P.L.31-2021, SEC.4.

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