Vermont H0031 modifies health insurance claim edit standards and prior authorization requirements for health care providers.

Vermont H0031 amends the definition of a primary care provider to exempt orders from prior authorization requirements. It also modifies the adherence to claim edit standards, allowing exceptions when necessary to comply with laws or when edits are more favorable to providers. The bill specifies that health plans should not impose prior authorization requirements for admissions, items, services, treatments, or procedures ordered by a primary care provider, except for prescription drugs or out-of-network services. The changes take effect on January 1, 2026.

Vermont H0031 modifies health insurance claim edit standards and prior authorization requirements for health care providers.

Vermont H0031 amends the definition of a primary care provider to exempt orders from prior authorization requirements. It also modifies the adherence to claim edit standards, allowing exceptions when necessary to comply with laws or when edits are more favorable to providers. The bill specifies that health plans should not impose prior authorization requirements for admissions, items, services, treatments, or procedures ordered by a primary care provider, except for prescription drugs or out-of-network services. The changes take effect on January 1, 2026.