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  • Summary date: Feb 15 2023 - View Summary

    Amends GS 135-48.1 to remove language in the definition of “Claim Payment Data” which permitted a claims processor for the North Carolina State Health Plan for Teachers and State Employees (SHP) to designate claim payment data as a trade secret under GS 66-152(3). Also no longer provides that the term includes any document, material, or other work, whether tangible or electronic, that is derived from, is based on, or reflects any of the foregoing data fields or information contained therein. Creates new subdivision (13a) defining “Non-Contracted Third Party” as an entity or individual submitting a claim for services or items provided to a SHP member that does not have a direct contractual relationship with a SHP claims processor governing the processing and payment of the claim and that did not submit the claim directly to the claims process for processing and payment. 

    Amends GS 135-48.32 to require a SHP claims processor, upon request, to provide the SHP with claim payment data showing the rates negotiated with or agreed to by Non-Contracted Third Parties (was, claims processor is not required to disclose claim payment data that reflects rates negotiated with or agreed to by a noncontracted third party, but must, upon request, provide sufficient documentation to support the payment of claims for which the data is withheld). Exempts claim payment data from GS Chapter 132 or any other provision making the records public information. Makes conforming deletions. Removes provisions prohibiting the SHP from using claim payment data to negotiate rates, fee schedules, or other master charges with providers and sharing claim payment data with third parties without a claim processor’s consent. Requires notice to a claims processor, instead of agreement, before making the SHP disclose claim payment data to a third party. Provides a claims processor who discloses claim payment data in accordance with the statute with immunity from monetary relief in connection with the disclosure. Adds a new subsection (h) establishing that only the SHP and a SHP claims processor have standing to bring judicial or administrative actions to enforce the statute.