28 CCR §1300.67.13(a)(2-3)
August 28, 2020 5:50 pm(2) A COB provision may not relieve a plan of a duty otherwise arising from a plan contract to deliver... View more
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28 CCR §1300.71(h)(3)
August 28, 2020 5:50 pm28 CCR §1300.71(h)(3): A request for information necessary to determine payer liability from a third party shall not extend the... View more
28 CCR §1300.71(d)(6)
August 28, 2020 5:49 pmA plan or a plan’s capitated provider may only offset an uncontested notice of reimbursement of the overpayment of a... View more
28 CCR §1300.71(a)(10)
August 28, 2020 5:49 pm“Reasonably relevant information” means the minimum amount of itemized, accurate and material information generated by or in the possession of... View more
Lauderdale Associates d.b.a. Alhambra Convalescent Hosp. v. California Department of Health Service Cal App 1d AO80227 (1998)
August 28, 2020 5:48 pmLauderdale Associates d.b.a. Alhambra Convalescent Hosp. v. California Department of Health Service Cal App 1d AO80227 (1998): “Health plans cannot... View more
Health & Safety Code §1371.36(a)
August 28, 2020 5:48 pm(a) A health care service plan shall not deny payment of a claim on the basis that the plan, medical... View more
Valley View Home of Beaumont, Inc. v. Department of Health Services (1983) 146 Cal.App.3d 161
August 28, 2020 5:47 pm“Notwithstanding the fact that medical services for Valley View’s disabled patients were medically necessary during the periods in question, the... View more
CA Business & Professions Code §511.1(c)
August 28, 2020 5:46 pmBeginning July 1, 2000, a payor, as defined in subparagraph (B) of paragraph (3) of subdivision (d), shall do all... View more
28 CCR §1300.71(a)(8)(T)
August 28, 2020 5:45 pmAn attempt to rescind or modify an authorization for health care services after the provider renders the service in good... View more
Health & Safety Code §1371.5(c)
August 28, 2020 5:44 pm(c) The determination as to whether an enrollee reasonably believed that the medical condition was an emergency medical condition that... View more