CO Rev. Stat. §10-16-112.5(3)(a)(I)
August 8, 2021 9:47 am(A) Notify the provider and covered person, within five business days after receipt of the request, that the request is... View more
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CO Rev. Stat. §10-16-112.5(3)(a)(II)
August 8, 2021 2:44 am(a)Except as provided in subsection (3)(b) of this section, a prior authorization request is deemed granted if a carrier or... View more
CO Rev. Stat. §10-16-113(2-3)
August 8, 2021 3:41 am(2) Following a denial of a request for benefits or an adverse determination by the carrier, the carrier shall notify the... View more
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
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