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
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CO Rev. Stat. §10-16-113(3)(b)(III)(A)
August 8, 2021 8:20 am(III)(A) A physician shall evaluate the first-level appeal and shall consult with an appropriate clinical peer or peers, unless the... View more
CO Rev. Stat. §10-16-113(3)(b)(IV)(A)
August 8, 2021 8:20 am(IV)(A) The second-level internal review of an appeal from the denial of a request for covered benefits pursuant to subparagraph... View more
CO Rev. Stat. §10-16-704(4.5)(b-c)
August 8, 2021 3:19 am(b) Except as otherwise provided in this subsection (4.5), adjustments to claims by the provider or the carrier shall be made... View more
CO Rev. Stat. §10-16-704(4.5)(L)(I)
August 8, 2021 3:18 am(L)(I) Any adjustment made by the carrier that recovers carrier overpayments to a provider shall include a written notice to... 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
CO Rev. Stat. §10-16-704(5.5)(a)
August 8, 2021 2:03 pm(a) Notwithstanding any provision of law, a carrier that provides any benefits with respect to services in an emergency department... View more
CO Rev. Stat. §10-16-704(5.5)(b)(I)(A)
August 8, 2021 9:26 am(I) ”Emergency medical condition” means a medical condition that manifests itself by acute symptoms of sufficient severity, including severe pain, that... View more
CO Rev. Stat. §10-16-704(5.5)(b)(II)(A-B)
August 8, 2021 2:03 pm(II) “Emergency services”, with respect to an emergency medical condition, means: (A) A medical screening examination that is within the capability of... View more
GA Code §33-20A-62(a-b)
October 15, 2021 5:42 am(a) No carrier, plan, network, panel, or any agent thereof may conduct a postpayment audit or impose a retroactive denial... View more