6 TIC §843.350(a-b)
August 17, 2021 5:24 pm(a) A health maintenance organization may recover an overpayment to a physician or provider if: (1) not later than the... View more
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NY Ins L §4904(c)
August 17, 2021 5:05 pm(c) A utilization review agent shall establish a standard appeal process which includes procedures for appeals to be filed in writing... View more
CO Rev. Stat. §10-16-104(3)(a)(I-III)
August 16, 2021 8:32 am(3) Maternity coverage. (a) (I) (A) All group sickness and accident insurance policies providing coverage within the state and issued to an... View more
CO Rev. Stat §10-16-106.5(5)(a-b)
August 16, 2021 8:18 am(a) A carrier that fails to pay, deny, or settle a clean claim in accordance with paragraph (a) of subsection (4)... View more
6 TIC §843.342(a-c)
August 15, 2021 9:59 am(a) Except as provided by this section, if a clean claim submitted to a health maintenance organization is payable and... View more
6 TIC §843.255(c)
August 8, 2021 3:13 pm(c) The physicians or other providers on a complaint appeal panel must have experience in the area of care that... View more
NY Ins L §4904(d)
August 8, 2021 3:11 pm(d) Both expedited and standard appeals shall only be conducted by clinical peer reviewers, provided that any such appeal shall be... View more
NY Ins L §4903(a)(2-3)
August 8, 2021 3:10 pm(a) Utilization review shall be conducted by: (2) A health care professional who is appropriately trained in the principles, procedures and standards... View more
8 TIC §1271.155(b)
August 8, 2021 2:09 pm(b) A health care plan of a health maintenance organization must provide the following coverage of emergency care: (1) a... View more
6 TIC §843.002(7)
August 8, 2021 2:08 pm(7) “Emergency care” means health care services provided in a hospital emergency facility… to evaluate and stabilize medical conditions of... View more