Subject 120-2-59 STANDARD CLAIM FORM FOR ACCIDENT AND SICKNESS INSURANCE
This Regulation is issued pursuant to the authority vested in
the Commissioner of Insurance by O.C.G.A. Sections
33-2-9 and
33-24-10.1.
The purpose of this Regulation Chapter is to implement the
provisions of Chapter 24 of Title 33 of the Official Code of Georgia Annotated,
provide for a standardized form to be used in the billing and reimbursement of
health care, reduce the number of forms utilized and increase efficiency in the
reimbursement of health care through standardization.
| (1) |
Except as otherwise specifically
provided, this Regulation Chapter shall apply to all issuers, health care
practitioners, and institutional care practitioners. |
| (2) |
Nothing in this Regulation Chapter shall
prohibit an issuer, health care practitioner or institutional care practitioner
from using alternative forms or procedures for filing claims as are specified
in a written contract between the health care practitioner or institutional
care practitioner and issuer. |
For the purposes of O.C.G.A.
33-24-10.1
and this Regulation Chapter:
| (a) |
"HCFA" means the Health Care Financing Administration of the United States
Department of Health and Human Services. |
| (b) |
"HCFA Form 1450" means the health
insurance claim form maintained by HCFA for use by institutional care
practitioners. |
| (c) |
"HCFA Form 1500"
means the health insurance claim form maintained by HCFA for use by health care
practitioners. |
| (d) |
"Health Care
Practitioner" means a health care provider duly licensed by the Secretary of
State of the State of Georgia pursuant to the Official Code of Georgia
Annotated and the Rules and Regulations of the State of Georgia. |
| (e) |
"Institutional Care Practitioner" means a
hospice, hospital, skilled nursing facility, extended care facility,
intermediate care facility, convalescent nursing home, and personal care
facility licensed pursuant to the Official Code of Georgia Annotated and the
Rules and Regulations of the State of Georgia. |
| (f) |
"Insured" means an individual covered
under a policy of insurance or the provider to which that individual has
assigned benefits. |
| (g) |
"Issuer"
means an insurance company, fraternal benefit society, health care service
plan, health maintenance organization, third party administrator, and any other
entity reimbursing the costs of health care expenses. |
| (h) |
"J512 Form" means the uniform dental
claim form approved by the American Dental Association for use by
dentists. |
| (1) |
Health care
practitioners and institutional care practitioners shall use and accept the
most current editions of the HCFA Form 1450, HCFA Form 1500, or J512 Form and
most current instructions for these forms in the billing of patients or their
representatives and filing claims with issuers. |
| (2) |
Issuers shall provide, upon request, to
health care practitioners, institutional care practitioners and insureds, and
accept the most current editions of the HCFA Form 1450, HCFA Form 1500, or J512
Form for the processing of claims. |
If any provision of this Regulation Chapter or the
application thereof to any person or circumstance is for any reason held to be
invalid, the remainder of the Regulation Chapter and the application of such
provision to other persons or circumstances shall not be affected
thereby.
