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House advances H.31 to clarify claim-edit standards and prior authorization exemptions
Summary
The Vermont House ordered third reading on H.31 after lawmakers said the bill clarifies how insurers apply claim-editing standards, limits application to out-of-state claims unless agreed otherwise, and defines which providers qualify as "primary care" for prior-authorization exemptions.
Representative Black, the member from Essex and floor sponsor for the Committee on Health Care, presented H.31, saying the bill "is a culmination of those discussions" and asking the House to advance it to third reading.
The bill would amend how insurers apply claim-editing coding rules and clarify which providers qualify as "primary care" for purposes of certain prior-authorization exemptions. Section 1 would add an exemption so that claim-editing standards do not apply to health-care services provided outside Vermont unless the payer and the out-of-state provider agree otherwise. Representative Black told members that processing of claims is governed by the location of the provider and…
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