All Companies Authorized to Write Health Insurance In Illinois : Nonparticipating Facility-Based Physicians and Providers Dispute-215ILCS 5 / 356z.3a

Illinois Department of Insurance PAT QUINN Governor TO: FROM: DATE: RE: MICHAEL T. McRAITH Director ALL COMPANIES AUTHORIZED TO WRITE HEALTH INSURANCE IN ILLINOIS DAVID GRANT ~__ z:S;: 2- ASSISTANT DEPUTY DIRECTOR HEALTH INSURANCE PRODUCTS JUNE 2, 2011 COMPANY BULLETIN 2011-07 NONPARTICIPATING FACILITY-BASED PHYSICIANS AND PROVIDERS DISPUTE-215ILCS 5/356z.3a June 1, 2011, E~!t2lis:~.{\.~t~~2(2::JS:?;l (Nonparticipating facility-based physicians and providers) is effective; allowing insurers, health plans and nonparticipating facility-based physicians or providers to initiate binding arbitration to detennine payment for covered services. Under Section 356z.3a of the Illinois Insurance Code (215 ILCS 5/356z.3a), nonpmiicipating facility-based radiologists, anesthesiologists, pathologists, neonatologists and emergency department providers, as well as insurers and health plans, may request binding arbitration if attempts to negotiate reimbursement for covered services rendered fail. If a party initiates binding arbitration as provided for under this Section, the noninitiating party is required to pmiicipate. The ability to exercise the rights set forth within this Section applies to all policies or contracts issued, renewed or modified on or after June 1, 2011, the effective date of the Act. Pursuant to Section 5/356z.3a, the Illinois Department ofInsurance is required to publish a list of American Arbitration Association or American Health Lawyers Association trained arbitrators or approved entities that will provide binding arbitration services. In accordance with this Section, the Depmiment has designated the American Arbitration Association and the American Health Lawyers Association as Approved Entities to provide binding arbitration. A party desiring to initiate arbitration of a disputed claim payment must submit its request through one of the following entities: American Arbitration Association Website: Address: Phone: Fax number: Email: }y_W.\Y-'.c.~(lL91:g. American Arbitration Association Case Filing Services 1101 Laurel Oak Road, Suite 100 Voorhees, NJ 08043 877-495-4185 877-304-8457 C'l~cfili!}g@'ldl:':'(.l..[g 320 West Washington St. Springfield. Illinois 62767-0001 (217) 782-45 I5 American Health Lawyers Association Website: Address: Phone: Fax number: Email: www.hcalthlawycrs.org American Health Lawyers Association 1620 Eye Street, NW, 6th Floor Washington, DC 20006-4010 (202) 833-1100 (202) 833-1105 The entity selected by the initiating party shall serve as the Approved Entity that will provide binding arbitration services in connection with the specific matter. All requests must clearly identify that binding arbitration is being initiated pursuant to Section 356z.3a - Nonparticipating facility-based physician and provider disputes, using the guidelines of the entity you have chosen. Further, all such requests must be copied to the Illinois Department of Insurance. The date of such request shall constitute notice to the Department and shall be used to detennine the 45 day timeframe for the arbitrator to issue his or her written decision. Correspondence which does not clearly identify the request for binding arbitration as being filed pursuant to Section 356z.3a - Nonparticipating facility-based physician and provider disputes and does not copy the Illinois Department of Insurance, will not qualify for relief or remedies afforded under the Act. All copies of requests for initiating binding arbitration must be electronically sent to the Department through the following address: Any questions concerning the impact or implementation of Public Act 096-1523 (Nonpaliicipating facility-based physicians and providers), may be directed to the Office of Consumer Health Insurance Toll Free at (877) 527-9431. 320 West Washington St. Springfield, Illinois 62767-000 I (217) 782-4515