republic-os/legislation/us/states/va/2024/sb-425.md

type, title, description, jurisdiction, legislature, session, identifier, citation, classification, subjects, status, primary_sponsors, version_count, action_count, vote_count, first_action, last_action, source, source_identifier, source_url, source_hash, vintage, source_snapshot, retrieved_at, confidence, tags

type	title	description	jurisdiction	legislature	session	identifier	citation	classification	subjects	status	primary_sponsors	version_count	action_count	vote_count	first_action	last_action	source	source_identifier	source_url	source_hash	vintage	source_snapshot	retrieved_at	confidence	tags
Bill	Health insurance; ethics and fairness in carrier business practices.	Health insurance; ethics and fairness in carrier business practices. Makes various changes to requirements governing the business practices of health carriers in the processing and payment of claims. The bill prescribes criteria for what constitutes a "clean claim." The bill prohibits a carrier from imposing any retroactive denial of a previously paid claim or in any other way seeking recovery or refund of a previously paid claim unless the carrier specifies in writing the specific claim or claims for which the retroactive denial is to be imposed or the recovery or refund is sought and the carrier has provided a written explanation of why the claim is being retroactively adjusted. The bill provides that the time limit for a retroactive denial is 12 months; however, a provider and a carrier may agree in writing that recoupment of overpayments by withholding or offsetting against future payments may occur after such 12-month limit. The bill requires carriers, beginning no later than July 1, 2025, to make available an electronic means for providers to determine whether an enrollee is covered by a health plan that is subject to the State Corporation Commission's jurisdiction. The bill provides that the ethics and fairness requirements apply to the carrier and provider, regardless of any vendors, subcontractors, or other entities that have been contracted by the carrier or the provider to perform their duties. The bill provides that if a carrier's claim denial is overturned following completion of a dispute review, the carrier is required to consider the claims impacted by such decision as clean claims and all applicable laws related to the payment of a clean claim apply. The bill prohibits a provider from filing a complaint with the State Corporation Commission for failure to pay claims unless such provider has made a reasonable effort to confer with the carrier in order to resolve the issues related to all claims that are under dispute. Finally, the bill requires all provider contracts, amendments, and notices and certain other communications to be delivered electronically. This bill is identical to HB 123.	us/states/va	Virginia General Assembly	2024	SB 425	Virginia SB 425 (2024)	bill		enacted	Barbara A. Favola	4	30	5	2024-01-09	2024-03-28	openstates	ocd-bill/7c4a3964-fb0a-4702-a709-a2662fd3c81c	https://lis.virginia.gov/cgi-bin/legp604.exe?241+sum+SB425	5b5236511c39f34669bb8882bd5b6db9fab737715f5aa331662830e5aa79c2c0	2026-07-01	https://data.openstates.org/daily/2026-07-01/public.pgdump	2026-07-06	reported	legislation bill us-va

Virginia SB 425 (2024) — Health insurance; ethics and fairness in carrier business practices.

Health insurance; ethics and fairness in carrier business practices. Makes various changes to requirements governing the business practices of health carriers in the processing and payment of claims. The bill prescribes criteria for what constitutes a "clean claim." The bill prohibits a carrier from imposing any retroactive denial of a previously paid claim or in any other way seeking recovery or refund of a previously paid claim unless the carrier specifies in writing the specific claim or claims for which the retroactive denial is to be imposed or the recovery or refund is sought and the carrier has provided a written explanation of why the claim is being retroactively adjusted. The bill provides that the time limit for a retroactive denial is 12 months; however, a provider and a carrier may agree in writing that recoupment of overpayments by withholding or offsetting against future payments may occur after such 12-month limit. The bill requires carriers, beginning no later than July 1, 2025, to make available an electronic means for providers to determine whether an enrollee is covered by a health plan that is subject to the State Corporation Commission's jurisdiction. The bill provides that the ethics and fairness requirements apply to the carrier and provider, regardless of any vendors, subcontractors, or other entities that have been contracted by the carrier or the provider to perform their duties. The bill provides that if a carrier's claim denial is overturned following completion of a dispute review, the carrier is required to consider the claims impacted by such decision as clean claims and all applicable laws related to the payment of a clean claim apply. The bill prohibits a provider from filing a complaint with the State Corporation Commission for failure to pay claims unless such provider has made a reasonable effort to confer with the carrier in order to resolve the issues related to all claims that are under dispute. Finally, the bill requires all provider contracts, amendments, and notices and certain other communications to be delivered electronically. This bill is identical to HB 123.

Version chain

The bill's text revisions, in order — the diff chain from filing to enrollment.

1. CHAP0244 (committee substitute) — source
2. Committee substitute printed 24105801D-S1 (committee substitute) — source
3. Prefiled and ordered printed; offered 01/10/24 24102577D (committee substitute) — source
4. SB425ER (committee substitute) — source

Votes

• Reported from Commerce and Labor with substitute (15-Y 0-N) — 15–0 (pass) · upper
• Read third time and passed Senate (38-Y 0-N) — 38–0 (pass) · upper
• Constitutional reading dispensed (40-Y 0-N) — 40–0 (pass) · upper
• Reported from Labor and Commerce (19-Y 0-N) — 19–0 (pass) · lower
• VOTE: Block Vote Passage (98-Y 0-N) — 97–0 (pass) · lower

Sponsors

• Barbara A. Favola — primary (person)

Timeline

The legislative action history — every referral, reading, and vote.

• 2024-01-09 Prefiled and ordered printed; offered 01/10/24 24102577D filing, introduction
• 2024-01-09 Referred to Committee on Commerce and Labor referral-committee
• 2024-01-20 Impact statement from SCC (SB425)
• 2024-01-22 Senate committee, floor amendments and substitutes offered
• 2024-01-22 Reported from Commerce and Labor with substitute (15-Y 0-N) committee-passage
• 2024-01-22 Committee substitute printed 24105801D-S1 substitution
• 2024-01-24 Constitutional reading dispensed (40-Y 0-N)
• 2024-01-25 Read second time reading-2
• 2024-01-25 Reading of substitute waived
• 2024-01-25 Committee substitute agreed to 24105801D-S1 substitution
• 2024-01-25 Engrossed by Senate - committee substitute SB425S1 substitution
• 2024-01-26 Impact statement from SCC (SB425S1)
• 2024-01-26 Read third time and passed Senate (38-Y 0-N) passage, reading-3
• 2024-02-13 Placed on Calendar
• 2024-02-13 Read first time reading-1
• 2024-02-13 Referred to Committee on Labor and Commerce referral-committee
• 2024-02-15 Reported from Labor and Commerce (19-Y 0-N) committee-passage
• 2024-02-19 Read second time reading-2
• 2024-02-20 Read third time reading-3
• 2024-02-20 Passed House BLOCK VOTE (98-Y 0-N) passage
• 2024-02-20 VOTE: Block Vote Passage (98-Y 0-N) passage
• 2024-02-26 Enrolled enrolled
• 2024-02-26 Bill text as passed Senate and House (SB425ER) passage
• 2024-02-26 Signed by Speaker passage
• 2024-02-29 Signed by President passage
• 2024-03-05 Impact statement from SCC (SB425ER)
• 2024-03-11 Enrolled Bill Communicated to Governor on March 11, 2024 enrolled
• 2024-03-11 Governor's Action Deadline 11:59 p.m., April 8, 2024 executive-receipt
• 2024-03-28 Approved by Governor-Chapter 244 (effective 7/1/24) executive-signature
• 2024-03-28 Acts of Assembly Chapter text (CHAP0244)

Source

OpenStates / OpenCivicData bulk snapshot 2026-07-01; origin ocd-bill/7c4a3964-fb0a-4702-a709-a2662fd3c81c. Confidence: reported (aggregated from official Virginia legislature records).