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.
House committee substitute to the 1st edition makes the following changes. Amends GS 135-48.1, by amending the definition of the term Claim Payment Data by deleting the provision specifying 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. Amends GS 135-48.32 by adding that the State Health Plan for Teachers and State Employees (Plan) must not make any use or disclosure of the Claim Payment Data that would compromise the proprietary nature of the data, or, as applicable, its status as a trade secret, or otherwise misappropriate the data. Also prohibits the Plan from using a provider's Claim Payment Data to negotiate rates, fee schedules, or other master changes with that provider or any other provider. Allows the Plan to disclose Claim Payment Data to a third party auditor to verify the legitimacy of claims paid on behalf of the Plan. Makes any disclosure to a third-party auditor subject to this statute with regard to the use and further disclosure of Claim Payment Data. Deletes the provision providing that a Claims Processor who discloses Claim Payment Data in accordance with this statute will not incur any civil liability and is not subject to equitable relief in connection for the disclosure. Adds instead that anyone who discloses Claim Payment Data in violation of the statute is subject to a civil penalty no greater than $250 per violation.
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