VirginiaHB6762026 Regular SessionHouseWALLET

Health insurance claims; electronic attachments accepted, delayed effective date.

Sponsored By: Michelle Lopes Maldonado (Democratic)

Became Law

Summary

Health insurance; carrier business practices; electronic attachments. Provides that, in the following contexts, information may be submitted by a provider to a health insurance carrier through electronic attachment, as defined in the bill: (i) information related to services rendered as required by the carrier in its provider contract; (ii) information related to any defect or impropriety that prevents the carrier from deeming a health insurance claim a clean claim, as defined in existing law; and (iii) information required to establish medical necessity, benefit coverage, or prior authorization of services, or to conduct reconsideration activities. The bill has a delayed effective date of January 1, 2027. This bill is identical to SB 172.

General Laws and Technology

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Bill Overview

Analyzed Economic Effects

7 provisions identified: 4 benefits, 0 costs, 3 mixed.

Law mostly starts January 1, 2027

Most rules take effect on January 1, 2027. Some parts of the law have earlier dates noted in those sections.

Faster payments and online claim fixes

Carriers must pay clean claims within 40 days. If a claim has a defect, they must notify the submitter within 30 days and accept the fix as a compliant electronic attachment. Starting January 1, 2026, these defect notices and related information must be sent electronically. If interest is owed on a late claim, it must be paid with the claim or within 60 days. If a payment method charges provider fees, the carrier must offer a no‑fee option. If a denial is overturned in dispute review, the claim is treated as a clean claim for prompt payment.

Fewer take-backs, pay approved care

If a carrier already said a service was medically necessary and covered, it must pay the claim, with limited exceptions like fraud, missing documentation, other-payer responsibility, prior payment, or unknown ineligibility. Carriers must also pay for extra, medically necessary procedures found during surgery when coded and submitted correctly. Retroactive denials or recoveries are limited to clear reasons, capped to 12 months unless both sides agree, and require at least 30 days’ advance notice. Starting January 1, 2026, these recovery notices must be delivered electronically, using the method named in the contract.

Provider protections, disputes, and remedies

Providers who lose money because a carrier broke this law can sue for actual damages, and up to triple damages for gross negligence and willful conduct. They can also recover attorney fees and court costs, and each improper claim is a separate violation. Carriers cannot retaliate against providers for using their rights. Before filing a Commission complaint about unpaid claims, providers must try to confer with the carrier and wait 30 days unless the carrier is unresponsive. These duties apply even if carriers or providers use vendors or subcontractors. The Commission may issue rules to implement this law but cannot decide individual disputes under this section.

Clearer contracts and policy access

When a carrier offers a provider contract, it must include the fee schedule, reimbursement policy, how claims are calculated and paid, and all material attachments. Providers can confirm coverage and medical necessity by free phone or online, and carriers must accept needed information electronically, including attachments. Carriers must share coding, bundling, and downcoding rules and, if asked, provide applicable policies within 10 business days. If a carrier wants to change contract terms, it must give 60 days’ notice, and the provider has 30 days to choose to end the contract.

No bias against patients in lawsuits

Provider contracts must bar discrimination against patients just because they are litigants, such as after a motor vehicle accident. A provider may still refuse care if that patient threatened or filed a malpractice or regulatory claim against the provider. If a provider repeatedly violates this rule and does not fix it, the Commission can refer the case to the Board of Medicine or the Health Commissioner for enforcement.

Coverage checks and contracts go online

Beginning July 1, 2025, carriers must give providers an electronic way to confirm if a patient is covered and under the Commission’s jurisdiction. By July 1, 2025, carriers must send provider contracts and notices electronically (not by fax). By January 1, 2026, providers must send contracts and notices to carriers electronically (not by fax). Contracts must state the agreed electronic method and location.

Sponsors & Cosponsors

Sponsor

  • Michelle Lopes Maldonado

    Democratic • House

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 222 • No: 1

Senate vote 2/26/2026

Passed Senate Block Vote

Yes: 40 • No: 0

Senate vote 2/25/2026

Constitutional reading dispensed Block Vote (on 2nd reading)

Yes: 40 • No: 0

Senate vote 2/25/2026

Passed by for the day Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote 2/23/2026

Reported from Commerce and Labor

Yes: 14 • No: 0

House vote 2/11/2026

Read third time and passed House

Yes: 98 • No: 0

House vote 2/5/2026

Reported from Labor and Commerce with substitute

Yes: 21 • No: 1

House vote 2/3/2026

Subcommittee recommends reporting with substitute

Yes: 9 • No: 0 • Other: 1

Actions Timeline

  1. Acts of Assembly Chapter text (CHAP0200)

    4/6/2026Governor
  2. Approved by Governor-Chapter 200 (effective 7/1/2026)

    4/6/2026Governor
  3. Governor's Action Deadline 11:59 p.m., April 13, 2026

    3/10/2026Governor
  4. Enrolled Bill communicated to Governor on March 10, 2026

    3/10/2026House
  5. Fiscal Impact Statement from State Corporation Commission (HB676)

    3/5/2026House
  6. Bill text as passed House and Senate (HB676ER)

    3/3/2026House
  7. Enrolled

    3/3/2026House
  8. Signed by President

    3/3/2026Senate
  9. Signed by Speaker

    3/3/2026House
  10. Passed Senate Block Vote (40-Y 0-N 0-A)

    2/26/2026Senate
  11. Read third time

    2/26/2026Senate
  12. Passed by for the day Block Vote (Voice Vote)

    2/25/2026Senate
  13. Constitutional reading dispensed Block Vote (on 2nd reading) (40-Y 0-N 0-A)

    2/25/2026Senate
  14. Rules suspended

    2/25/2026Senate
  15. Reported from Commerce and Labor (14-Y 0-N)

    2/23/2026Senate
  16. Fiscal Impact Statement from State Corporation Commission (HB676)

    2/17/2026House
  17. Referred to Committee on Commerce and Labor

    2/12/2026Senate
  18. Constitutional reading dispensed (on 1st reading)

    2/12/2026Senate
  19. Read third time and passed House (98-Y 0-N 0-A)

    2/11/2026House
  20. Engrossed by House - committee substitute

    2/10/2026House
  21. committee substitute agreed to

    2/10/2026House
  22. Read second time

    2/10/2026House
  23. Read first time

    2/9/2026House
  24. Committee substitute printed 26106262D-H1

    2/5/2026House
  25. Reported from Labor and Commerce with substitute (21-Y 1-N)

    2/5/2026House

Bill Text

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