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Law Requiring Insurers to Accept Electronically Submitted Workers’ Compensation Bills Will FINALLY Be Enforced!
Posted on: 8/23/2019

In 2018, ISMS delivered a big win for physicians and patients regarding workers' comp payments with the enactment of Senate Bill 904

One of the provisions of this bill requires workers' compensation insurers to accept claims that are submitted electronically. Good news! The rules that the Illinois Department of Insurance (DOI) developed have been finalized. 

The journey of this new law had not been an easy one. The ISMS legislative team worked hard on behalf of Illinois physicians to help get this bill passed in the Illinois House and Senate, but then-Governor Rauner vetoed the bill. During the fall veto session, ISMS was again at the forefront of this fight. Lawmakers then overrode the veto and Senate Bill 904 became law. 

But not so fast. The DOI, then under the Rauner administration, delayed issuing rules regarding electronic billing. When they finally did issue the rules, they were inadequate and failed to provide any real change or enforcement.  ISMS kept fighting to make sure the rules met the intent of the law.  

Fortunately, under the Pritzker Administration, and after much hard work by ISMS, the rules have finally been amended to enforce the law. 

Going forward, if workers’ comp insurance companies do not accept your electronic bills, file a complaint with the DOI. ISMS will help all members with this processContact the ISMS advocacy team by calling 800-782-4767, ext. 1470, or by sending an email.

Another provision of this legislation requires workers’ compensation insurers to issue an Explanation of Benefits (EOB) when medical bills are not paid in a timely manner. These rules are still pending. The ISMS legislative team assessed the draft rules and identified these key problems:  

  • Lack of definitive language on whether an electronically submitted claim would warrant an electronic EOB.
  • Lack of specific language stating that an EOB will be sent within 30 days of receipt of the bill if the claim is denied, or if the bill does not largely contain all the required data elements necessary to adjudicate the claim.
  • Absence of language requiring the Director of Insurance to impose an administrative fine if it is determined that an employer or insurer has failed to comply with the electronic claims acceptance and response process, including the issuance of an EOB.  

ISMS will continue advocating for administrative rules pertaining to EOBs so that they are reflective of the law. 

If you have any questions, please contact ISMS Vice President of Legislative Affairs Erin O'Brien at 312-580-6488.


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