HB606 Alabama 2012 Session

Summary

Primary Sponsor

Phil Williams

Republican

Session

Regular Session 2012

Title

Health care providers, certain health insurers, health maintenance organizations, statewide claim-dispute-resolution program established, Health Department to administer

Summary

HB606 would create a statewide dispute-resolution program for health-care claims, run by the Alabama Department of Public Health with a third-party resolution organization to review disputes between providers and certain health benefit plans.

What This Bill Does

It would establish a program by January 1, 2013 for unresolved provider–health benefit plan disputes, with a qualified independent third-party resolution organization reviewing disputes and making recommendations to the Department of Public Health. The department would adopt rules to run the program and define what disputes are eligible or ineligible. It sets timelines and procedures, including documentation submission and potential default or dismissal for noncompliance, and creates costs and penalties for nonpayment of review fees. It also requires monitoring and reporting on noncompliance and annual updates to the Governor and Legislature about outcomes like dismissals, defaults, and noncompliance.

Who It Affects

• Health care providers who submit disputes about claim determinations and may receive recommendations or orders after review.
• Health benefit plans, including insurers and HMOs, that may have disputes reviewed and could be subject to costs, defaults, or penalties if they do not comply.
• Resolution organizations hired to review disputes and issue recommendations within set timeframes.
• The Department of Public Health, which would administer the program, adopt rules, issue final orders, and monitor compliance (including notifying licensure entities of violations).

Key Provisions

• Establishes a statewide claim-dispute-resolution program for provider vs. health benefit plan disputes, to be administered by the State Department of Public Health.
• Requires the department to contract with a qualified independent third-party resolution organization to review disputes and recommend resolutions to the department.
• Defines key terms (Department, Health Benefit Plan, Provider, Resolution Organization) and sets eligibility, including jurisdictional amounts and aggregation methods.
• Lists disputes that are ineligible for review (e.g., interest-only disputes, non-state-regulated plans, Medicare internal grievance, Medicaid fair hearings, ongoing court actions, or binding preexisting dispute resolutions).
• Allows contracts after the effective date to require exhaustion of internal dispute processes before submitting to the resolution organization.
• Imposes a 12-month filing limit after a final determination; requires timely document submission (15 days) and allows extensions; noncompliance can lead to dismissal or default with monetary consequences.
• The resolution organization must issue a written recommendation with findings within 60 days (up to 90 days maximum) after information is received; the department must adopt the recommendation as a final order within 30 days.
• The nonprevailing party must pay the resolution cost, with rules for apportionment; penalties up to $500 per day may be imposed for nonpayment.
• The department will monitor for patterns of noncompliance, report findings to licensure/certification entities, and prepare annual reports for the Governor and Legislature detailing dismissals, defaults, and failures to comply.
• The act becomes effective on the first day of the third month after it is enacted into law.

AI-generated summary using openai/gpt-5-nano on Feb 24, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Health Care Providers