KRS 304.17C-136: Definitions for section -- Prohibition against payment method

restrictions for dental benefit plan -- Electronic fund transfer payments.

(1) As used in this section:

(a) "Credit card payment":

1. Means a type of electronic funds transfer in which a dental benefit plan

or its contracted vendor issues a single -use series of numbers associated

with the payment of dental services:

a. Performed by a dentist and chargeable to a predetermined dollar

amount; and

b. For which the dentist is respons ible for processing the payment by

a credit card terminal or Internet portal; and

2. Shall include virtual or online credit card payments for which no

physical credit card is presented to the dentist and the single -use credit

card expires upon payment processing;

(b) "Dentist agent" means a person that establishes an agency relationship

contract with a dentist to process bills for services provided by the dentist

under terms and conditions established between the agent and dentist. Such

contracts may permit the dentist agent to submit bills, request reconsideration,

and receive reimbursement; and

(c) "Electronic funds transfer payment":

1. Means a payment by any method of electronic funds transfer other than

health care electronic fund transfer and remittanc e advice transactions

under 45 C.F.R. secs. 162.1601 and 162.1602; and

2. Shall include virtual credit card payments.

(2) A dental benefit plan shall not contain restrictions on methods of payment from the

dental benefit plan or its vendors to the dentist in which the only acceptable

payment method is a credit card payment.

(3) When initiating or changing payments to a dentist using electronic funds transfer

payments, a dental benefit plan or its vendors shall:

(a) Notify the dentist if any fees are associated with a particular payment method;

(b) Advise the dentist of the available methods of payment; and

(c) Provide clear instructions to the dentist as to how to select an alternative

payment method.

(4) (a) A denta l benefit plan or its vendor that initiates or changes payments to a

dentist for health care electronic fund transfer and remittance advice

transactions under 45 C.F.R. secs. 162.1601 and 162.1602 shall not charge a

fee solely to transmit the payment to th e dentist unless the dentist has

consented to the fee.

(b) When transmitting health care electronic fund transfer and remittance advice

transactions under 45 C.F.R. secs. 162.1601 and 162.1602, a dentist agent

may charge reasonable fees for payments relate d to transaction management,

data management, portal services, and other value -added services in addition

to the bank transmittal.