Lauderdale Associates d.b.a. Alhambra Convalescent Hosp. v. California Department of Health Service Cal App 1d AO80227 (1998): “Health plans cannot... View more
(a) A clean claim must be paid within 45 days after receipt of the claim by the health plan. A... View more
(a) A clean claim must be paid within 45 days after receipt of the claim by the health plan. A... View more
(j) That when an adverse determination is made, a written statement containing the reasons for the adverse determination is provided... View more
“…if the plan approved the furnishing of a service through an advance determination of coverage, it may not deny coverage... View more
(1) Each entity offering individual and group health insurance policies providing coverage on an expense-incurred basis, individual and group service... View more
(13) If an authorized representative of a health carrier authorizes the provision of health care services, the health carrier shall... View more
(2) Any medical director who administers the utilization review program or oversees the review decisions shall be a qualified health... View more
(2) For determinations, a health carrier shall make the determination within thirty-six hours, which shall include one working day, of... View more
(5) A written notification of an adverse determination shall include the principal reason or reasons for the determination, including the... View more