28 CCR §1300.71.4(b)
August 28, 2020 5:12 pm(b) In the case when an enrollee is stabilized but the health care provider believes that the enrollee requires additional... View more
Archives
Health and Safety Code §1371.8
August 28, 2020 5:11 pmA health care service plan that authorizes a specific type of treatment by a provider shall not rescind or modify... View more
28 CCR §1300.71(b)(5)
August 28, 2020 5:11 pm(5) A plan or a plan’s capitated provider shall not request reimbursement for the overpayment of a claim, including requests... View more
Health and Safety Code §1371.1(a)(1)
August 28, 2020 5:10 pm(a)(1) Whenever a health care service plan, including a specialized health care service plan, determines that in reimbursing a claim for... View more
Health and Safety Code §1367.01(h)(4)
August 28, 2020 5:10 pm(h)(4) Responses regarding decisions to deny, delay, or modify health care services requested by providers prior to, retrospectively, or concurrent... View more
Health and Safety Code §1371.4(c)
August 28, 2020 5:09 pm(c) …a healthcare service plan shall not require a provider to obtain authorization prior to the provision of emergency services... View more
Health and Safety Code §1370.2
August 28, 2020 5:05 pmThis health care provider or the medical director shall review the appeal and, if he or she determines that he... View more
Health and Safety Code §1367.62(a)(1-2)
August 28, 2020 5:04 pm(a) No health care service plan contract that is issued, amended, renewed, or delivered on or after the effective date of... View more
Health and Safety Code §1367.62(a)(7)
August 28, 2020 5:04 pm(a) No health care service plan contract that is issued, amended, renewed, or delivered on or after the effective date... View more
28 CCR § 1300.67(g)(2)
August 28, 2020 5:01 pm(2) …Emergency services defined in section 1317.1 include active labor. “Urgently needed services” are those services necessary to prevent serious... View more