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
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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
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
28 CCR §1300.71(3)(B)
August 28, 2020 5:30 pm(B) For contracted providers without a written contract and non-contracted providers, except those providing services described in paragraph (C) below:... 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
28 CCR §1300.71(a)(3)(A)
August 28, 2020 5:32 pm(A) For contracted providers with a written contract, including in-network point-of-service (POS) and preferred provider organizations (PPO): the agreed upon... View more
28 CCR §1300.71(a)(6)
August 28, 2020 5:32 pm(a)(6): “Date of receipt” means the working day when a claim, by physical or electronic means, is first delivered to... 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
28 CCR §1300.71(b)(1)
August 28, 2020 5:28 pm(1) Neither the plan nor the plan’s capitated provider that pays claims shall impose a deadline for the receipt of... View more
28 CCR §1300.71(b)(2)(A)
August 28, 2020 5:36 pm(2) If a claim is sent to a plan that has contracted with a capitated provider that is responsible for... View more