| All insurers providing individual medical expense insurance on |
| an expense-incurred basis providing payment or reimbursement for |
| diagnosis or treatment of a condition or a complaint by a health |
| care practitioner must accept the current standardized claim form |
| for professional services approved by the Federal Government and |
| submitted electronically. All insurers providing individual |
| medical expense insurance on an expense-incurred basis providing |
| payment or reimbursement for diagnosis or treatment of a |
| condition or a complaint by a licensed hospital must accept the |
| current standardized claim form for professional or facility |
| services, as applicable, approved by the Federal Government and |
| submitted electronically. An insurer may not be required to |
| accept a claim submitted on a form other than the applicable form |
| specified in this section and may not be required to accept a |
| claim that is not submitted electronically, except from a health |
| care practitioner who is exempt pursuant to Title 24, section |
| 2985. All services provided by a health care practitioner in an |
| office setting must be submitted on the standardized federal form |
| used by noninstitutional providers and suppliers.__Services in a |
| nonoffice setting may be billed as negotiated between the insurer |
| and health care practitioner. For purposes of this section, |
| "office setting" means a location where the health care |
| practitioner routinely provides health examinations, diagnosis |
| and treatment of illness or injury on an ambulatory basis whether |
| or not the office is physically located within a facility. |
