Health Insurance Portability and Accountability Act: means the Health Insurance Portability and Accountability Act of 1996, Pub. See Utah Code 31A-1-301
Insurance: includes :
(i)
a risk distributing arrangement providing for compensation or replacement for damages or loss through the provision of a service or a benefit in kind;
(ii)
a contract of guaranty or suretyship entered into by the guarantor or surety as a business and not as merely incidental to a business transaction; and
(iii)
a plan in which the risk does not rest upon the person who makes an arrangement, but with a class of persons who have agreed to share the risk. See Utah Code 31A-1-301
Person: includes :
(a)
an individual;
(b)
a partnership;
(c)
a corporation;
(d)
an incorporated or unincorporated association;
(e)
a joint stock company;
(f)
a trust;
(g)
a limited liability company;
(h)
a reciprocal;
(i)
a syndicate; or
(j)
another similar entity or combination of entities acting in concert. See Utah Code 31A-1-301
certificate of interest or participation in a profit-sharing agreement;
(vii)
collateral-trust certificate;
(viii)
preorganization certificate or subscription;
(ix)
transferable share;
(x)
investment contract;
(xi)
voting trust certificate;
(xii)
certificate of deposit for a security;
(xiii)
certificate of interest of participation in an oil, gas, or mining title or lease or in payments out of production under such a title or lease;
(xiv)
commodity contract or commodity option;
(xv)
certificate of interest or participation in, temporary or interim certificate for, receipt for, guarantee of, or warrant or right to subscribe to or purchase any of the items listed in Subsections (171)(a)(i) through (xiv); or
(xvi)
another interest or instrument commonly known as a security. See Utah Code 31A-1-301
State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
(a)
Except as provided in Subsection (1)(c), an insurer offering health insurance shall use a uniform claim form and uniform billing and claim codes.
(b)
Beginning January 1, 2011, all health benefit plans, and dental and vision plans, shall provide for the electronic exchange of uniform:
(i)
eligibility and coverage information; and
(ii)
coordination of benefits information.
(c)
For purposes of Subsection (1)(a), “health insurance” does not include a policy or certificate that provides benefits solely for:
When adopting rules under this section the commissioner:
(i)
shall:
(A)
consult with national and state organizations involved with the standardized exchange of health data, and the electronic exchange of health data, to develop the standards for the use and electronic exchange of uniform:
(I)
claim forms;
(II)
billing and claim codes;
(III)
insurance eligibility and coverage information; and
(IV)
coordination of benefits information; and
(B)
meet federal mandatory minimum standards following the adoption of national requirements for transaction and data elements in the federal Health Insurance Portability and Accountability Act;
(ii)
may not require an insurer or administrator to use a specific software product or vendor; and
(iii)
may require an insurer who participates in the all payer database created under Section 26B-8-504 to allow data regarding demographic and insurance coverage information to be electronically shared with the state’s designated secure health information master person index to be used:
(A)
in compliance with data security standards established by:
(I)
the federal Health Insurance Portability and Accountability Act; and
(II)
the electronic commerce agreements established in a business associate agreement; and
(B)
for the purpose of coordination of health benefit plans.
(3)
(a)
The commissioner shall coordinate the administrative rules adopted under the provisions of this section with the administrative rules adopted by the Department of Health and Human Services for the implementation of the standards for the electronic exchange of clinical health information under Section 26B-8-411. The department shall establish procedures for developing the rules adopted under this section, which ensure that the Department of Health and Human Services is given the opportunity to comment on proposed rules.
(b)
(i)
The commissioner may provide information to health care providers regarding resources available to a health care provider to verify whether a health care provider’s practice management software system meets the uniform electronic standards for data exchange required by this section.
(ii)
The commissioner may provide the information described in Subsection (3)(b)(i) by partnering with:
(A)
a not-for-profit, broad based coalition of state health care insurers and health care providers who are involved in the electronic exchange of the data required by this section; or
(B)
some other person that the commissioner determines is appropriate to provide the information described in Subsection (3)(b)(i).
(c)
The commissioner shall regulate any fees charged by insurers to the providers for:
(i)
uniform claim forms;
(ii)
electronic billing; or
(iii)
the electronic exchange of clinical health information permitted by Section 26B-8-411.
(4)
This section does not require a person to provide information concerning an employer self-insured employee welfare benefit plan as defined in 29 U.S.C. § 1002(1).
