NJ Admin Code §11:24-5.2(a)(3)
October 15, 2021 5:31 am(a) The HMO shall provide or arrange for the provision of the following basic comprehensive health services as medically necessary:... View more
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Mo. Rev. Stat. §376.1363(5)
October 15, 2021 5:30 am(5) A written notification of an adverse determination shall include the principal reason or reasons for the determination, including the... View more
Mo. Rev. Stat. §376.384(1)(3)
October 15, 2021 5:30 am(1) All health carriers shall: (3) Not request a refund or offset against a claim more than twelve months after... View more
Mo. Rev. Stat. §376.1361(13)
October 15, 2021 5:29 am(13) If an authorized representative of a health carrier authorizes the provision of health care services, the health carrier shall... View more
RI Gen L § 27-18.9-6(a)(1-2)
October 15, 2021 5:26 am(1) For urgent or emergent healthcare services, benefit determinations (adverse or non-adverse) shall be made as soon as possible taking... View more
RI Gen L § 27-41-64(a)
October 15, 2021 5:26 am(a) A health care entity or health plan operating in the state shall pay all complete claims for covered health... View more
NJ Admin Code § 11:24-8.3(c)(1)(ii)
October 15, 2021 5:25 am(c) All determinations shall be made on a timely basis, as required by the exigencies of the situation. (1) An... View more
NJ Admin Code §11:22-1.6(c)
October 15, 2021 5:23 am(c) If the carrier or its agent fails to pay a clean claim within the time limits set forth in... View more
NJ Admin Code §11:22-1.8(b)
October 15, 2021 5:20 am(b) A health carrier or its agent may request reimbursement for the overpayment of a claim only if the health... View more
NJ Admin Code § 11:24-8.3(d)
October 15, 2021 5:18 am(d) An HMO shall not reverse a utilization management decision where the provider relied upon the written or oral authorization... View more