AN ACT ALLOWING THE NORTH CAROLINA STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES TO ACCESS AND UTILIZE ITS OWN CLAIMS PAYMENT DATA WHILE CONTINUING TO PROTECT THE CONFIDENTIALITY OF THE INFORMATION.
Identical to H 169, filed 2/25/21.
Amends GS 135-48.1, which sets forth defined terms used under the provisions governing the State Health Plan for Teachers and State Employees (SHP), to include data fields that reflect the rate negotiated with or agreed to by the provider in the term Claim Payment Data.
Amends GS 135-48.32 to require the SHP Claims Processor to disclose the Claim Payment Data on a member level for claims paid by State funds. Now requires the Claims Processor to disclose Claim Payment Data that reflects rates negotiated with or agreed to by a noncontracted third party (previously not required, but required provisions of documentation to SHP to support payment of claims). Modifies the confidentiality provisions as follows. No longer specifically prohibits use or disclosure of Claim Payment Data that would compromise the or misappropriate the data. Exempts Claim Payment Data from public records laws. No longer prohibits SHP from using Claim Payment Data to negotiate rates, fee schedules, or other master changes with providers. No longer qualifies SHP's authority to disclose Claim Payment Data to third parties to use on SHP's behalf on the agreement of the Claims Processor. Now requires SHP to provide notice to, rather than obtain the approval of, the Claims Processor for each third party SHP seeks to disclose to or who will make use of Claim Payment Data.
Effective January 1, 2022.