Florida SB 1198: Purple Alert

Bill Text

1198 
Health Insurance Claims 
2026-01-06T07:29:10Z 
Expanding the scope of the statewide provider and health plan claim dispute resolution program to include resolution of denied prior authorization requests; providing that participation in the program is mandatory and prohibiting providers and health plans from opting out of the claim dispute resolution process; prohibiting contracts between certain physicians and health insurers and health maintenance organizations, respectively, from specifying credit card payments to physicians as the only acceptable method for payments; authorizing use of electronic funds transfers by health insurers and health maintenance organizations, respectively, for payments to physicians under certain circumstances, etc. 
Original Filed Version 
2026 
S 
2026-07-01T00:00:00Z 
GB 
General Bill 
__ 

 Florida Senate - 2026 SB 1198 

 By Senator Massullo 

 11-00318A-26 20261198__ 
 1 A bill to be entitled 
 2 An act relating to health insurance claims; amending 
 3 s. 408.7057, F.S.; defining the term “denied prior 
 4 authorization request”; expanding the scope of the 
 5 statewide provider and health plan claim dispute 
 6 resolution program to include resolution of denied 
 7 prior authorization requests; providing that 
 8 participation in the program is mandatory and 
 9 prohibiting providers and health plans from opting out 
 10 of the claim dispute resolution process; revising 
 11 circumstances under which a claim dispute is exempt 
 12 from the program’s claim dispute resolution process; 
 13 providing that respondents in claim disputes may not 
 14 avoid imposition of a default by declining to 
 15 participate in the claim dispute resolution process; 
 16 providing for reimbursement of reasonable costs to 
 17 providers if the health plan is determined to be the 
 18 nonprevailing party in a claim dispute involving a 
 19 denied prior authorization request; requiring the 
 20 Agency for Health Care Administration to adopt certain 
 21 rules; amending ss. 627.6131 and 641.315, F.S.; 
 22 prohibiting contracts between certain physicians and 
 23 health insurers and health maintenance organizations, 
 24 respectively, from specifying credit card payments to 
 25 physicians as the only acceptable method for payments; 
 26 authorizing use of electronic funds transfers by 
 27 health insurers and health maintenance organizations, 
 28 respectively, for payments to physicians under certain 
 29 circumstances; providing notification requirements; 
 30 prohibiting health insurers and health maintenance 
 31 organizations, respectively, from charging fees for 
 32 automated clearinghouse transfers as claims payments 
 33 to physicians; providing an exception; providing 
 34 applicability; prohibiting health insurers and health 
 35 maintenance organizations, respectively, from denying 
 36 claims subsequently submitted by physicians for 
 37 procedures that were included in prior authorizations; 
 38 providing exceptions; providing applicability; 
 39 amending ss. 409.967 and 627.64194, F.S.; conforming 
 40 provisions to changes made by the act; providing an 
 41 effective date. 
 42 
 43 Be It Enacted by the Legislature of the State of Florida: 
 44 
 45 Section 1. Section 408.7057, Florida Statutes, is amended 
 46 to read: 
 47 408.7057 Mandatory statewide provider and health plan claim 
 48 dispute resolution program.— 
 49 (1) As used in this section, the term: 
 50 (a) “Agency” means the Agency for Health Care 
 51 Administration. 
 52 (b) “Denied prior authorization request” means, with 
 53 respect to a request submitted by a provider for prior 
 54 authorization of a health care service, supply, or medication, a 
 55 health plan has made a determination that the request is wholly 
 56 or partially disapproved, has not been acted upon within the 
 57 time limits established by law or contract, or is approved 
 58 subject to materially restrictive conditions that prevent the 
 59 service, supply, or medication from being furnished as 
 60 clinically indicated. 
 61 (c) “Health plan” means a health maintenance organization 
 62 or a prepaid health clinic certified under chapter 641, a 
 63 prepaid health plan authorized under s. 409.912, an exclusive 
 64 provider organization certified under s. 627.6472, or a major 
 65 medical expense health insurance policy, as defined in s. 
 66 627.643(2)(e), offered by a group or an individual health 
 67 insurer licensed pursuant to chapter 624, including a preferred 
 68 provider organization under s. 627.6471. 
 69 (d)(c) “Resolution organization” means a qualified 
 70 independent third-party claim-dispute-resolution entity selected 
 71 by and contracted with the Agency for Health Care 
 72 Administration. 
 73 (2)(a) The agency shall establish a program to provide 
 74 assistance to contracted and noncontracted providers and health 
 75 plans for resolution of claim disputes and denied prior 
 76 authorization requests that are