215 ILCS 5/368b
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 368b.     Contracting procedures.(a) A health care professional or health care provider offered a contract by  an  insurer, health maintenance organization,  independent practice association, or physician  hospital organization for signature after the effective date of this amendatory  Act of the  93rd General Assembly shall be provided with a proposed health care  professional or  health care provider  services contract including, if any, exhibits and attachments that the contract  indicates are  to be attached. Within 35 days after a written request, the health care  professional or health  care provider offered a contract shall be given the opportunity to review and  obtain a  copy of the following: a specialty-specific fee schedule sample based on a  minimum of  the 50 highest volume fee schedule codes with the rates applicable to the  health care  professional or health care provider to whom the contract is offered, the  network  provider  administration manual, and a summary capitation schedule, if payment is made on  a  capitation basis. If 50 codes do not exist for a particular specialty, the  health care  professional or health care provider offered a contract shall be given the  opportunity to  review or obtain a copy of a fee schedule sample with the codes applicable to  that  particular specialty. This information may be provided electronically. An  insurer, health  maintenance organization, independent practice  association, or physician hospital  organization may substitute the fee schedule sample with a document providing  reference  to the information needed to calculate the fee schedule that is available to  the public at no  charge and the percentage or conversion factor at which the insurer, health  maintenance  organization, preferred provider organization, independent practice  association, or physician hospital organization sets its rates.(b) The fee schedule, the capitation schedule, and  the network provider  administration manual constitute confidential, proprietary, and trade secret  information and are subject to the provisions of the Illinois Trade Secrets  Act.  The health  care professional or health care provider receiving such protected information  may disclose  the information on a need to know basis and only to individuals and entities  that provide  services directly related to the health care professional's or health care  provider's decision  to enter into the contract or keep the contract in force. Any person or entity  receiving or  reviewing such protected information pursuant to this Section shall not  disclose  the  information to any other person, organization, or entity, unless the disclosure  is requested  pursuant to a valid court order or required by a state or federal government  agency.  Individuals or entities receiving such information from a health care  professional  or health care provider as delineated in this subsection are subject to the  provisions of the  Illinois Trade Secrets Act.(c) The health care professional or health care provider shall be allowed at  least  30 days to review the health care professional or health care provider services  contract, including  exhibits and  attachments, if any, before signing. The 30-day review period begins upon  receipt of the  health care   professional or health care provider services contract, unless the information  available  upon request  in subsection (a) is not included. If information is not included in the  professional  services contract and is requested pursuant to subsection (a), the 30-day  review period  begins on the date of receipt of the information. Nothing in this subsection  shall prohibit  a health care professional or health care provider from signing a contract  prior to the  expiration of the 30-day review period.(d) The insurer, health maintenance organization,  independent practice  association, or physician hospital organization shall provide all contracted  health care  professionals or health care providers with any changes to the fee schedule  provided  under subsection (a) not later than 35 days after the effective date of the  changes,  unless such  changes are specified in the contract and the health care professional or  health care  provider is able to calculate the changed rates based on information in the  contract and  information available to the public at no charge. For the purposes of this  subsection,  "changes" means an increase or decrease in the fee schedule referred to in  subsection (a).  This information may be made available by mail, e-mail, newsletter, website  listing, or  other reasonable method. Upon request, a health care professional or health  care provider  may request an updated copy of the fee schedule referred to in subsection (a)  every  calendar quarter.(e) Upon termination of a contract with an insurer, health maintenance  organization, independent practice  association, or physician hospital  organization and at  the request of the patient, a health care professional or health care provider  shall transfer  copies of the patient's medical records. Any other provision of law  notwithstanding, the  costs for copying and transferring copies of medical records shall be assigned  per the  arrangements agreed upon, if any, in the health care professional or health  care provider services  contract.    (Source: P.A. 93-261, eff. 1-1-04.)