Health & Safety Code §1371.4(d)
August 28, 2020 5:57 pmIf there is a disagreement between the health care service plan and the provider regarding the need for necessary medical... View more
Archives
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
Health & Safety Code §1371(a)(1)
August 28, 2020 5:51 pm(a)(1) A health care service plan, including a specialized health care service plan, shall reimburse each complete claim, or portion... View more
Health & Safety Code 1371.37(c)(2)
August 28, 2020 5:31 pm(C) “An ‘unfair payment pattern,’ as used in this section means any of the following: (2) Engaging in a demonstrable... View more
Health and Safety Code §1367.01(h)(1)
August 28, 2020 4:58 pm(h) In determining whether to approve, modify, or deny requests by providers prior to, retrospectively, or concurrent with the provision... View more
Health and Safety Code §1367.01(h)(4)
August 28, 2020 5:10 pm(h)(4) Responses regarding decisions to deny, delay, or modify health care services requested by providers prior to, retrospectively, or concurrent... View more
Health and Safety Code §1367.62(a)(1-2)
August 28, 2020 5:04 pm(a) No health care service plan contract that is issued, amended, renewed, or delivered on or after the effective date of... View more
Health and Safety Code §1367.62(a)(7)
August 28, 2020 5:04 pm(a) No health care service plan contract that is issued, amended, renewed, or delivered on or after the effective date... View more
Health and Safety Code §1370.2
August 28, 2020 5:05 pmThis health care provider or the medical director shall review the appeal and, if he or she determines that he... View more
Health and Safety Code §1371.1(a)(1)
August 28, 2020 5:10 pm(a)(1) Whenever a health care service plan, including a specialized health care service plan, determines that in reimbursing a claim for... View more