NJ Admin Code § 11:24-8.3(c)(1)(i)
October 15, 2021 5:17 am(c) All determinations shall be made on a timely basis, as required by the exigencies of the situation. (1) An... View more
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NJ Admin Code §11:22-1.5(a)
October 15, 2021 5:16 am(a) A carrier and its agent shall remit payment of clean claims pursuant to the following time frames: (1) Thirty... View more
Mo. Rev. Stat. §376.1363(2)
October 15, 2021 5:16 am(2) For determinations, a health carrier shall make the determination within thirty-six hours, which shall include one working day, of... View more
Mo. Rev. Stat. §376.383(6)(1)
October 15, 2021 5:15 am(6)(1) If the health carrier has not paid the claimant on or before the forty-fifth processing day from the date... View more
Mo. Rev. Stat. §376.1210(1)
October 15, 2021 5:15 am(1) Each entity offering individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service... View more
Mo. Rev. Stat. §376.1361(2)
October 15, 2021 5:14 am(2) Any medical director who administers the utilization review program or oversees the review decisions shall be a qualified health... View more
Mo. Rev. Stat. §376.1367(1)
October 15, 2021 5:13 am(1) A health carrier shall cover emergency services necessary to screen and stabilize an enrollee, as determined by the treating... View more
Mo. Rev. Stat. §376.1367(4)
October 15, 2021 5:11 am(4) When an enrollee receives an emergency service that requires immediate post evaluation or post stabilization services, a health carrier... View more
MI HMO Script – Untimely Payment
October 13, 2021 12:43 pmASK YOURSELF: What date was the claim initially billed? Was there any written communication (request for information, denial, underpayment) from... View more
MI HMO Script – Notice Requirements for Adverse Determinations
October 13, 2021 12:32 pmASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more