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
Archives
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
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
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