AMENDMENT FOR PRINTED BILL
108ja
___________________ moved that SB 108 be amended as follows:
On the printed bill, delete everything after the enacting clause and insert:
" Section 1. No third party payor, excluding Medicare, who makes a payment to a provider on the
behalf of a covered beneficiary in South Dakota may deny payment to a provider based solely on a
perceived or claimed inaccuracy in the assignment of an International Statistical Classification
Disease-10 (ICD-10) diagnosis on a claim submitted by a provider on behalf of a covered beneficiary
for a service covered under the beneficiary's health benefit plan.
A provider and payor shall make all reasonable and necessary efforts to resolve disagreements
regarding correct ICD-10 diagnosis codes in a timely and expedient fashion. However, in no event
may this reconciliation take more than ninety days.
If, at the end of the ninety day reconciliation period between a provider and a payor that concerns
a disagreement that arises from a submitted ICD-10, no resolution or agreement has been reached,
the payor may pursue its standard dispute resolution and claims process covered under an agreement
between provider and payor.
This Act does not apply to providers and payors not operating under a provider network
agreement with each other on the date of the service for which the claim is submitted. A payor may
continue its standard dispute resolution and claims process with providers who are not under any
agreement or that are out of the payor's network.
Section 2. This Act is repealed nine months after the implementation of the International
Statistical Classification of Disease-10."