§33-15B-3. Health care authority to promulgate rules; use of standardized forms and classifications; advisory group. (a) The West Virginia health care authority shall promulgate legislative rules in accordance with the provisions of chapter twenty-nine-a of this code regarding the implementation and use of uniform health care administrative forms. Such rules shall establish, where practicable, the acceptance and use throughout the health care system of standard administrative forms, terms or procedures, including, but not limited to, the following:
(1) The standard health care financing administration fifteen hundred (HCFA 1500) health insurance claim form, as amended, or other similar forms, terms, and definitions to be used which are consistent with health care and insurance industry standards.
(2) International classification of disease, ninth clinical modifications (ICD-9-CM) and common procedural terminology (CPT) codes, as amended, or other similar forms, terms, and definitions to be used which are consistent with health care and insurance industry standards.
(3)National uniform billing data element specifications (UB-92), as amended, and as supplemented by the West Virginia uniform billing committee, or other similar forms, terms, and definitions to be used which are consistent with health care and insurance industry standards.
(4) Consideration of current practices involving reimbursement of claims and explanation of benefits, and the implementation of standards and guidelines regarding explanation of benefits, including, but not limited to, consideration of line item explanations of payments or denial of payments.
(b) The legislative rules required herein shall be developed by the West Virginia health care authority with the advice of an advisory group to be appointed by the board of the West Virginia health care authority. Such advisory group shall consist of representatives of consumers, providers, payors, and regulatory agencies, including representatives from the following: The office of the insurance commissioner; the West Virginia health care authority; West Virginia dental association; West Virginia pharmacists association; the West Virginia hospital association; commercial health insurers; third party administrators; the West Virginia state medical association; the West Virginia nurses association; public employees insurance agency; workers' compensation commission; and consumers. The West Virginia health care authority shall form such advisory group after the effective date of this section.
(c) The West Virginia health care authority and the advisory group shall review the legislative rules effected pursuant to this section as necessary and update the same in a timely manner in order to conform to current legislation and health care and insurance industry standards and trends.
§33-15B-3. Health care authority to promulgate rules; use of standardized forms and classifications; advisory group. (a) The West Virginia health care authority shall promulgate legislative rules in accordance with the provisions of chapter twenty-nine-a of this code regarding the implementation and use of uniform health care administrative forms. Such rules shall establish, where practicable, the acceptance and use throughout the health care system of standard administrative forms, terms or procedures, including, but not limited to, the following:
(1) The standard health care financing administration fifteen hundred (HCFA 1500) health insurance claim form, as amended, or other similar forms, terms, and definitions to be used which are consistent with health care and insurance industry standards.
(2) International classification of disease, ninth clinical modifications (ICD-9-CM) and common procedural terminology (CPT) codes, as amended, or other similar forms, terms, and definitions to be used which are consistent with health care and insurance industry standards.
(3)National uniform billing data element specifications (UB-92), as amended, and as supplemented by the West Virginia uniform billing committee, or other similar forms, terms, and definitions to be used which are consistent with health care and insurance industry standards.
(4) Consideration of current practices involving reimbursement of claims and explanation of benefits, and the implementation of standards and guidelines regarding explanation of benefits, including, but not limited to, consideration of line item explanations of payments or denial of payments.
(b) The legislative rules required herein shall be developed by the West Virginia health care authority with the advice of an advisory group to be appointed by the board of the West Virginia health care authority. Such advisory group shall consist of representatives of consumers, providers, payors, and regulatory agencies, including representatives from the following: The office of the insurance commissioner; the West Virginia health care authority; West Virginia dental association; West Virginia pharmacists association; the West Virginia hospital association; commercial health insurers; third party administrators; the West Virginia state medical association; the West Virginia nurses association; public employees insurance agency; workers' compensation commission; and consumers. The West Virginia health care authority shall form such advisory group after the effective date of this section.
(c) The West Virginia health care authority and the advisory group shall review the legislative rules effected pursuant to this section as necessary and update the same in a timely manner in order to conform to current legislation and health care and insurance industry standards and trends.
§33-15B-3. Health care authority to promulgate rules; use of standardized forms and classifications; advisory group. (a) The West Virginia health care authority shall promulgate legislative rules in accordance with the provisions of chapter twenty-nine-a of this code regarding the implementation and use of uniform health care administrative forms. Such rules shall establish, where practicable, the acceptance and use throughout the health care system of standard administrative forms, terms or procedures, including, but not limited to, the following:
(1) The standard health care financing administration fifteen hundred (HCFA 1500) health insurance claim form, as amended, or other similar forms, terms, and definitions to be used which are consistent with health care and insurance industry standards.
(2) International classification of disease, ninth clinical modifications (ICD-9-CM) and common procedural terminology (CPT) codes, as amended, or other similar forms, terms, and definitions to be used which are consistent with health care and insurance industry standards.
(3)National uniform billing data element specifications (UB-92), as amended, and as supplemented by the West Virginia uniform billing committee, or other similar forms, terms, and definitions to be used which are consistent with health care and insurance industry standards.
(4) Consideration of current practices involving reimbursement of claims and explanation of benefits, and the implementation of standards and guidelines regarding explanation of benefits, including, but not limited to, consideration of line item explanations of payments or denial of payments.
(b) The legislative rules required herein shall be developed by the West Virginia health care authority with the advice of an advisory group to be appointed by the board of the West Virginia health care authority. Such advisory group shall consist of representatives of consumers, providers, payors, and regulatory agencies, including representatives from the following: The office of the insurance commissioner; the West Virginia health care authority; West Virginia dental association; West Virginia pharmacists association; the West Virginia hospital association; commercial health insurers; third party administrators; the West Virginia state medical association; the West Virginia nurses association; public employees insurance agency; workers' compensation commission; and consumers. The West Virginia health care authority shall form such advisory group after the effective date of this section.
(c) The West Virginia health care authority and the advisory group shall review the legislative rules effected pursuant to this section as necessary and update the same in a timely manner in order to conform to current legislation and health care and insurance industry standards and trends.
