28 CCR §1300.71(b)(2)(B)
August 28, 2020 5:38 pm(2) If a claim is sent to a plan that has contracted with a capitated provider that is responsible for... View more
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28 CCR §1300.71(b)(3)
August 28, 2020 5:38 pm(b)(3) If a claim is sent to the plan’s capitated provider and the plan is responsible for adjudicating the claim,... View more
28 CCR §1300.71(b)(4)
August 28, 2020 5:29 pm(4) A plan or a plan’s capitated provider that denies a claim because it was filed beyond the claim filing... View more
28 CCR §1300.71(b)(5)
August 28, 2020 5:11 pm(5) A plan or a plan’s capitated provider shall not request reimbursement for the overpayment of a claim, including requests... View more
28 CCR §1300.71(d)(6)
August 28, 2020 5:49 pmA plan or a plan’s capitated provider may only offset an uncontested notice of reimbursement of the overpayment of a... View more
28 CCR §1300.71(e)(6-8)
August 28, 2020 5:40 pm(6) The plan’s contract with a claims processing organization or the capitated provider shall include provisions authorizing the plan to... View more
28 CCR §1300.71(g)
August 28, 2020 5:13 pm(g) A plan or a plan’s capitated provider shall reimburse each complete claim whether in state or out of state,... View more
28 CCR §1300.71(h)(3)
August 28, 2020 5:50 pm28 CCR §1300.71(h)(3): A request for information necessary to determine payer liability from a third party shall not extend the... View more
28 CCR §1300.71(i)(1-2)
August 28, 2020 4:59 pm(1) Late payment on a complete claim for emergency services and care, which is neither contested nor denied, shall automatically... View more
28 Pa. Code §9.672(b)
October 15, 2021 5:45 am(b) A plan may not deny any claim for emergency services on the basis that the enrollee did not receive... View more