Ohio Rev Code §3923.041(B)(4)(a)
October 15, 2021 5:36 am(a) For policies issued on or after January 1, 2018, if the health care practitioner submits the request for prior... View more
Archives
Ohio Rev Code §3901.381(B)(1)
October 15, 2021 5:36 am(B)(1) Unless division (B)(2) or (3) of this section applies, when a third-party payer receives from a provider or beneficiary... View more
RI Gen L § 27-18.9-6(a)(3)
October 15, 2021 5:35 am(3) For pre-service claims (adverse or non-adverse), within a reasonable period of time appropriate to the medical circumstances, but not... View more
RI Gen L § 27-41-30.1(a)
October 15, 2021 5:34 am(a) Every individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state... View more
RI Gen L § 27-41-64(d)
October 15, 2021 5:34 am(d) A health care entity or health plan which fails to reimburse the health care provider or policyholder after receipt... View more
RI Gen L § 27-18.9-7(b)(3)(iii-iv)
October 15, 2021 5:34 am(iii) When the appeal of any adverse benefit determination, including an appeal of a reconsideration decision, is based in whole... View more
RI Gen L § 27-41-79(c)(1)
October 15, 2021 5:33 am(c) A health maintenance organization shall provide coverage for emergency services in the following manner: (1) Without the need for... View more
RI Gen L § 27-18.9-6(b)(2)
October 15, 2021 5:33 am(2) Notification content shall: (i) Be culturally and linguistically appropriate; (ii) Provide details of a claim that is being denied... View more
RI Gen L § 27-41-69(a)
October 15, 2021 5:32 am(a) Except as otherwise provided herein, any review, audit, or investigation by a health maintenance organization of a healthcare provider’s... View more
NJ Admin Code §11:22-1.10(a)(4)
October 15, 2021 5:32 am(4) The health carrier or its agent shall communicate the results of the internal review in a written decision to... View more