ODI Addresses Provider Concerns on HB 1 Provisions

Effective October 16, providers who bill third party payers electronically must accept payments that are transmitted electronically to them by a payer as a result of a provision in House Bill 1. 

The Ohio Department of Insurance (ODI) has notified third party payers how the department intends to regulate the conduct of carriers in compliance with the new law, although details are still being worked out.  In a September 27th letter to carriers, the department points out that electronic payments creates two major concerns for physicians. 

First, providers are concerned that carriers intend to directly withdraw overpayments from a provider’s account.  ODI has informed payers that direct withdrawals by a third party payer from a provider’s account, which is used to receive electronic payments, would be a violation of the Ohio Revised Code. 

Second, providers are concerned that electronic payments create difficulties in reconciling payments with the explanations of benefits (EOBs).  ODI has instructed payers to develop payment and EOB  procedures that make recording and reconciliation of payments efficient and cost-effective. 

Some payers are already posting EOB information on websites to assist with the reconciliation process.  If you experience problems that you cannot resolve directly with a third party payer, please contact the OOA office.

For a copy of the Ohio Department of Insurance's guidance letter click here:  ODI House Bill 1 Guidance.