28 Pa. Code §9.705(c)(3)(i)
October 15, 2021 5:45 am(i) Both the initial and second level grievance review shall include a licensed physician or an approved licensed psychologist, in... View more
(i) Both the initial and second level grievance review shall include a licensed physician or an approved licensed psychologist, in... View more
(b) A plan may not deny any claim for emergency services on the basis that the enrollee did not receive... View more
(a) General rule.–Except as provided in section 3804 (relating to exceptions to retroactive denial of reimbursement), an insurer may not... View more
(a) A licensed insurer or a managed care plan shall pay a clean claim submitted by a health care provider... View more
(1) If the enrollee is admitted to a hospital or other health care facility, the emergency health care provider shall... View more
(vi) The plan shall notify the enrollee in writing of the decision of the initial review committee within 5 business... View more
(a) No carrier, plan, network, panel, or any agent thereof may conduct a postpayment audit or impose a retroactive denial... View more
(1) Except as otherwise provided in this subsection, an individual health benefit plan issued pursuant to this chapter that includes... View more
(B) Every individual or group policy of sickness and accident insurance that provides hospital, surgical, or medical expense coverage shall... View more
(A) A payment made by a third-party payer to a provider in accordance with sections 3901.381 to 3901.386 of the... View more