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Current as of January 01, 2025 | Updated by Findlaw Staff
1. Every health insurance carrier offering policies of insurance in this state shall use standardized information for the explanation of benefits given to the health care provider whenever a claim is paid or denied. As used in this section, the term “health insurance carrier” shall have the meaning given to “health carrier” in section 376.1350. Nothing in this section shall apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, short-term major medical policies of six months or less duration, other limited benefit health insurance policies.
2. The standardized information shall contain the following:
(1) The name of the insured;
(2) The insured's identification number;
(3) The date of service;
(4) Amount of charge;
(5) Explanation for any denial;
(6) The amount paid;
(7) The patient's full name;
(8) The name and address of the insurer; and
(9) The phone number to contact for questions on explanation of benefits.
3. All health insurance carriers shall use the standard explanation of benefits information after January 1, 2002.
Cite this article: FindLaw.com - Missouri Revised Statutes Title XXIV. Business and Financial Institutions § 376.1400. Explanation of benefits, standardized information used, contents, when - last updated January 01, 2025 | https://codes.findlaw.com/mo/title-xxiv-business-and-financial-institutions/mo-rev-st-376-1400/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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