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

ection, 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

o 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