GA Code §33-20A-7.1(b)
October 15, 2021 5:47 am(b) When an enrollee, provider, facility, or home health care provider obtains precertification for any covered health care service, the... View more
Archives
GA Code §33-24-59.14(b)(1)
October 15, 2021 5:46 am(b)(1) All benefits under a health benefit plan will be payable by the insurer or administrator which is obligated to... View more
28 Pa. Code §9.753(b)
October 15, 2021 5:46 am(b) A prospective UR decision shall be communicated to the plan, enrollee and health care provider within 2-business days of... View more
40 P.S §991.2166(b)
October 15, 2021 5:46 am(b) If a licensed insurer or a managed care plan fails to remit the payment as provided under subsection (a),... View more
31 Pa. Code §154.12(a)
October 15, 2021 5:45 am(a) Managed care plans shall permit enrollees direct access to obstetrical and gynecological services for maternity and gynecological care, including... View more
28 Pa. Code §9.705(c)(3)(i)
October 15, 2021 5:45 am(i) Both the initial and second level grievance review shall include a licensed physician or an approved licensed psychologist, in... View more
28 Pa. Code §9.672(b)
October 15, 2021 5:45 am(b) A plan may not deny any claim for emergency services on the basis that the enrollee did not receive... View more
40 PA.C.S §3803(a-b)
October 15, 2021 5:44 am(a) General rule.–Except as provided in section 3804 (relating to exceptions to retroactive denial of reimbursement), an insurer may not... View more
40 P.S §991.2166(a)
October 15, 2021 5:44 am(a) A licensed insurer or a managed care plan shall pay a clean claim submitted by a health care provider... View more
31 Pa. Code §154.14(e)(1)(a)
October 15, 2021 5:43 am(1) If the enrollee is admitted to a hospital or other health care facility, the emergency health care provider shall... View more