VirginiaSB1722026 Regular SessionSenateWALLET

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

Sponsored By: Stella G. Pekarsky (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 HB 676.

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Bill Overview

Analyzed Economic Effects

9 provisions identified: 7 benefits, 0 costs, 2 mixed.

Faster claim payments and interest for providers

Beginning January 1, 2027, carriers pay clean claims within 40 days unless they have a documented dispute. They must tell you within 30 days if a claim has a defect and what is missing. If you send the requested info as a compliant electronic attachment, that send date counts as receipt. Any interest owed is paid when the claim is paid or within 60 days. If a denial is overturned in dispute review, the claim becomes a clean claim on the decision date. Carriers must accept your documentation as electronic attachments.

Limits on retroactive payment take-backs

Beginning January 1, 2027, carriers cannot take back payment for a paid claim unless they name the exact claim, explain the reason in writing, and show fraud, an incorrect payment, or act within 12 months. They must give you at least 30 days’ advance notice. You and the carrier can agree in writing to a longer recovery period.

Payment when care was preauthorized

Beginning January 1, 2027, carriers must pay for services they authorized or said were covered, unless listed exceptions apply (like fraud, no service delivered, or another payer’s responsibility). If an authorized invasive procedure changes during surgery for medical reasons, carriers must pay for the necessary services when you code properly and follow post‑service claim rules.

Stronger enforcement rights for providers

Beginning January 1, 2027, if a carrier violates this law and you lose money, you can sue for actual damages. Courts can award up to three times damages for gross negligence or willful conduct, plus your attorney fees and costs. Before filing a Commission complaint about unpaid claims, you must try to resolve it with the carrier and, if they respond, wait 30 days after your request. Carriers may not drop or punish you for asserting your rights.

Clear contracts and fee-free payment options

Beginning January 1, 2027, any contract you are asked to sign must include the fee schedule and all material addenda and policies. Carriers must give at least 60 days’ notice before contract changes start. You have 30 days after receipt to say you will end the contract at the earliest allowed date. If a payment method charges you a fee, the contract must say so, and the carrier must offer a no‑fee option and pay that way if you enroll.

Upfront access to coverage and billing rules

Beginning January 1, 2027, carriers must let you confirm in advance if a service is medically necessary and covered and share preauthorization, coding, bundling/downcoding, and payment rules. If a carrier routinely bundles or downcodes, it must disclose that and give you the specific policies or electronic access within 10 business days, or clearly explain limits if copyright blocks full copies. Carriers must accept required support electronically when the contract references the standards.

Electronic contracts, notices, and coverage checks

Carriers and providers use agreed electronic delivery, not fax, for contracts, amendments, and notices. Carriers deliver electronically by July 1, 2025, and providers submit electronically by January 1, 2026; the section is effective January 1, 2027. Beginning January 1, 2027, carriers send all required claim notices electronically to the agreed address. Carriers also must give you an electronic way to check if a patient is covered.

State oversight, scope, and limits

Beginning January 1, 2027, carriers regulated under Title 38.2 must follow minimum fair‑business standards for contracts and claims, and the State Corporation Commission can enforce those standards and issue rules. The Commission does not adjudicate individual disputes under this section. If the Commission sees a pattern of provider discrimination and no fix, it may refer the case to the Board of Medicine or the Commissioner of Health. Carriers are not at fault when a failure is mainly caused by the submitter or by events beyond their reasonable control. The rules apply to carriers and their vendors and subcontractors.

No bias against patients in lawsuits

Beginning January 1, 2027, providers may not treat a patient worse just because the patient is a litigant or might become one after a car crash. This does not require a provider to treat someone who has threatened or made a malpractice claim against that provider. This rule appears in provider contracts.

Sponsors & Cosponsors

Sponsor

  • Stella G. Pekarsky

    Democratic • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 207 • No: 4

House vote 2/24/2026

Passed House

Yes: 97 • No: 1

House vote 2/19/2026

Reported from Labor and Commerce

Yes: 17 • No: 3

Senate vote 1/30/2026

Read third time and passed Senate Block Vote

Yes: 38 • No: 0

Senate vote 1/29/2026

Engrossed by Senate Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote 1/29/2026

Commerce and Labor Substitute agreed to

Yes: 0 • No: 0

Senate vote 1/28/2026

Passed by for the day Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote 1/28/2026

Constitutional reading dispensed Block Vote (on 1st reading)

Yes: 40 • No: 0

Senate vote 1/26/2026

Reported from Commerce and Labor with substitute

Yes: 15 • No: 0

Actions Timeline

  1. Acts of Assembly Chapter text (CHAP0201)

    4/6/2026Governor
  2. Approved by Governor-Chapter 201 (effective 7/1/2026)

    4/6/2026Governor
  3. Fiscal Impact Statement from State Corporation Commission (SB172)

    3/23/2026Senate
  4. Governor's Action Deadline 11:59 p.m., April 13, 2026

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

    3/10/2026Senate
  6. Bill text as passed Senate and House (SB172ER)

    2/26/2026Senate
  7. Enrolled

    2/26/2026Senate
  8. Signed by President

    2/26/2026Senate
  9. Signed by Speaker

    2/26/2026House
  10. Passed House (97-Y 1-N 0-A)

    2/24/2026House
  11. Read third time

    2/24/2026House
  12. Read second time

    2/23/2026House
  13. Reported from Labor and Commerce (17-Y 3-N)

    2/19/2026House
  14. Referred to Committee on Labor and Commerce

    2/4/2026House
  15. Read first time

    2/4/2026House
  16. Placed on Calendar

    2/4/2026House
  17. Read third time and passed Senate Block Vote

    1/30/2026Senate
  18. Engrossed by Senate Block Vote (Voice Vote)

    1/29/2026Senate
  19. Commerce and Labor Substitute agreed to

    1/29/2026Senate
  20. Engrossed by Senate - committee substitute

    1/29/2026Senate
  21. Read second time

    1/29/2026Senate
  22. Passed by for the day Block Vote (Voice Vote)

    1/28/2026Senate
  23. Constitutional reading dispensed Block Vote (on 1st reading) (40-Y 0-N 0-A)

    1/28/2026Senate
  24. Passed by for the day

    1/28/2026Senate
  25. Rules suspended

    1/28/2026Senate

Bill Text

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