Maine Legislature, Session 122, LD 0416
Committee Amendment CA_A_S85 (Senate)
Amends: 24-A MRSA §2, 24-A MRSA §423

COMMITTEE AMENDMENT ,A" to 
Act To Amend the Laws Regarding 
Claims" 
S.P. 140, L.D. 416, Bill, "An 
Submission of Health Insurance 
Amend the bill by striking out everything after the enacting 
clause and before the summary and inserting in its place the 
following: 
'Sec. 1. 24-A MRS A §1912, as amended by PL 2003, c. 469, Pt. 
D, §3 and affected by §9, is further amended to read: 
§1912. Standardized c1aim forms 
All administrators who administer claims and who provide 
payment 
or 
reimbursement 
for 
diagnosis 
or 
treatment 
of 
a 
condition or a complaint by a licensed health care practitioner 
must accept the current standardized claim form for professional 
services 
approved 
by 
the 
Federal 
Government 
and 
submitted 
electronically. 
All administrators who administer claims and who 
provide payment or reimbursement for diagnosis or treatment of a 
condition or a complaint by a licensed hospital must accept the 
current standardized claim form for professional or facility 
services, as applicable, approved by the Federal Government and 
submi tted electronically. 
An administrator may not be required 
to accept a claim submitted on a form other than the applicable 
form specified in this section and may not be required to accept 
a 
claim that is not submitted electronically, except from 
a 
health care practitioner who is exempt pursuant to Title 24, 
Page l-LR1474(2) 
COMMITTEE AMENDMENT 
?,. ~~. 
COMMITTEE AMENDMENT .~. to S.P. 140, L.D. 416 
section 
2985. 
A11 
services 
provided 
by 
a 
health 
care 
practitioner in an office setting must be 
submitted on the 
standardized federal form used by noninstitutional providers and 
su,ppliers. 
Services in a nonoffice setting may be bi11ed as 
negotiated 
between 
the 
administrator 
and 
heal th 
care 
practitioner. 
For purposes of this section. 
"office setting" 
means a location where the health care practitioner routinely 
provides health examinations. diagnosis and treatment of illness 
or l.nJUry on an ambulatory basis whether or not the office is 
physically located within a facility. 
Sec. 2. 24-A MRSA §2~153, as amended by PL 2003, c. 469, Pt. 
D, §6 and affected by §9, is further amended to read: 
§2753. Standardized claim forms 
All insurers providing individual medical expense insurance 
on an expense-incurred basis providing payment or reimbursement 
for diagnosis or treatment of a condition or a complaint by a 
health care practitioner must accept the current standardized 
claim form for professional services approved by the Federal 
Government and submitted electronically. 
All insurers providing 
individual medical expense insurance on an expense-incurred basis 
providing payment or reimbursement for diagnosis or treatment of 
a condition or a complaint by a licensed hospital must accept the 
current standardized claim form for professional or facility 
services, as applicable, approved by the Federal Government and 
submitted electronically. 
An 
insurer may not be required to 
accept a claim submitted on a form other than the applicable form 
specified in this section and may not be required to accept a 
claim that is not submitted electronically, except from a health 
care practitioner who is exempt pursuant to Title 24, section 
2985. 
All services provided by a health care practitioner in an 
office setting must be su~mitted on the standardized federal form 
used by noninstitutional providers and suppliers. 
Services in a 
nonoffice setting may be billed as negotiated between the insurer 
and health care practitioner. 
For purposes of this section. 
"office 
setting" 
meanS 
a 
location 
where 
the 
health 
care 
practitioner routinely provides health examinations. 
diagnosis 
and treatment of illness or injury on an ambulatory basis whether 
or not the office is physically located within a facility. 
Sec. 3. 24-AMRSA §2823-B, as amended by PL 2003, c. 469, Pt. 
D, §7 and affected by §9, is further amended to read: 
§2823-B. Standardized claim forms 
All insurers providing group medical expense insurance on an 
expense-incurred basis providing payment or 
reimbursement for 
diagnosis 
or 
treatment of 
a 
condition or 
a 
complaint by 
a 
COMMITTEE AMENDMENT 
~~~~ 
COMMITTEE AMENDMENT -A" to S.P. 140, L.D. 416 
licensed 
health 
care 
practitioner 
must 
accept 
the 
current 
standardized claim form for professional services approved by the 
Federal Government and submitted electronically. 
All insurers 
providing group medical expense insurance on an expense-incurred 
basis 
providing 
payment 
or 
reimbursement 
for 
diagnosis 
or 
treatment of a condition or a complaint by a licensed hospital 
must accept the current standardized claim form for professional 
or facility services, 
as applicable, 
approved by the Federal 
Government and submitted electronically. 
An insurer may not be 
required to accept a claim submitted on a form other than the 
applicable form specified in this section and may not be required 
to accept a claim that is not submitted electronically, except 
from a health care practitioner who is exempt pursuant to Title 
24, 
section 
2985. 
All 
services provided 
by 
a 
health care 
practitioner in an office setting must be 
submitted on the 
standardized federal form used by noninstitutional providers and 
suppliers. 
Services in a nonoffice setting may be billed as 
negotiated between the insurer and health care practitioner. For 
purposes of this section, "office setting" means a location where 
the 
health 
care 
practitioner 
routinely 
provides 
health 
examinations, diagnosis and treatment of illness or injury on an 
ambulatory basis whether or not the office is physically located 
within a facility. 
Sec. 4. 24-A MRSA §423S, as amended by PL 2003, c. 469, Pte 
D, §8 and affected by §9, is further amended to read: 
§4235. Standardized claim forms 
All health maintenance organizations providing payment or 
reimbursement for diagnosis or treatment of a condition or a 
complaint by a licensed health care practitioner must accept the 
current 
standardized 
claim 
form 
for 
professional 
services 
approved by the Federal Government and submitted electronically. 
All 
health 
maintenance ;. 
organizations 
providing 
payment 
or 
reimbursement for diagnosis or treatment of a condition or a 
complaint 
by 
a 
licensed 
hospital 
must 
accept 
the 
current 
standardized claim form for professional or facility services, as 
applicable, 
approved by the Federal Government 
and submitted 
electronically. 
A health maintenance organization may not be 
required to accept a claim submitted on a form other than the 
applicable form specified in this section and may not be required 
to accept a claim that is not submitted electronically, except 
from a health care practitioner who is exempt pursuant to Title 
24, 
section 
2985. 
All 
services 
provided 
by 
a 
health care 
practitioner in an office setting must be 
submitted on the 
standardized federal form used by noninstitutional providers and 
suppliers. 
Services in a nonoffice setting may be billed as 
negotiated between the health maintenance organization and health 
care practitioner. For purposes of this section, "office setting" 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT .. A to S.P. 140, L.D. 416 
means a location where the health care practitioner routinely 
provides health examinations. diagnosis and treatment of illness 
or injury on an ambulatory basis whether or not the office is 
physically located within a facility.' 
SUMMARY 
This amendment replaces the bill. The 
amendment requires 
that all health insurance claims for services of a health care 
practitioner provided in an office setting be submitted on the 
standard federal form known as the "CMS 1500" form published by 
the federal 
Centers 
for Medicare and Medicaid Services. 
The 
amendment also clarifies that claims for services provided in 
nonoffice settings may be negotiated. 
COMMITTEE AMENDMENT