6 TIC §843.350(b)
August 8, 2021 3:11 am(b) If a physician or provider disagrees with a request for recovery of an overpayment, the health maintenance organization shall... View more
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6 TIC §843.350(a)(1-2)
August 8, 2021 3:10 am(a) A health maintenance organization may recover an overpayment to a physician or provider if: (1) not later than the... View more
CO Rev. Stat. §10-16-704(4)
August 8, 2021 3:00 am(4) When a treatment or procedure has been preauthorized by the plan, benefits cannot be retrospectively denied except for fraud... View more
37 Fla. Stat. §641.3156 (1-2)
August 8, 2021 2:59 am(1) A health maintenance organization must pay any hospital-service or referral-service claim for treatment for an eligible subscriber which was authorized... View more
NY Ins L §3238(a)
August 8, 2021 2:58 am(a) An insurer, corporation organized pursuant to article forty-three of this chapter, municipal cooperative health benefits plan certified pursuant to... View more
6 TIC §843.348(g)
August 8, 2021 2:56 am(g) If the health maintenance organization has preauthorized health care services, the health maintenance organization may not deny or reduce... View more
CO Rev. Stat. §10-16-112.5(3)(a)(II)
August 8, 2021 2:44 am(a)Except as provided in subsection (3)(b) of this section, a prior authorization request is deemed granted if a carrier or... View more
CO Rev. Stat. §10-16-113(3)(a)(IV)
August 8, 2021 2:37 am(IV) A carrier shall notify an individual of a benefit determination, whether adverse or not, with respect to a request... View more
37 Fla. Stat. §641.495(4)
August 8, 2021 2:33 am(4) The organization shall ensure that the health care services it provides to subscribers, including physician services as required by s. 641.19(12)(d)... View more
37 Fla. Stat §641.513(3)(b-c)
August 8, 2021 2:27 am(b) If a determination has been made that an emergency medical condition exists and the subscriber has notified the hospital, or... View more