NY Ins L §3224-b(b)(1-3)
August 8, 2021 3:15 am(b) Overpayment to healthcare providers. (1) Other than recovery for duplicate payments, a health plan shall provide thirty days written notice... View more
Archives
NY Ins L §3238(a)
August 8, 2021 2:58 am(a) An insurer, corporation organized pursuant to article forty-three of this chapter, municipal cooperative health benefits plan certified pursuant to... View more
NY Ins L §4303(a)(2)(D)
August 8, 2021 2:07 pm(D) For the purpose of this provision, “emergency services” means, with respect to an emergency condition: (i) a medical screening examination... View more
NY Ins L §4903(a)(2-3)
August 8, 2021 3:10 pm(a) Utilization review shall be conducted by: (2) A health care professional who is appropriately trained in the principles, procedures and standards... View more
NY Ins L §4903(b)(1)
August 8, 2021 9:45 am(b)(1) A utilization review agent shall make a utilization review determination involving health care services which require pre-authorization and provide... View more
NY Ins L §4903(c)(1)
August 8, 2021 2:19 am(c)(1) A utilization review agent shall make a determination involving continued or extended health care services, additional services for an insured... View more
NY Ins L §4904(c-d)
August 8, 2021 3:38 am(c) A utilization review agent shall establish a standard appeal process which includes procedures for appeals to be filed in writing... View more
NY Ins L §4904(c)
August 17, 2021 5:05 pm(c) A utilization review agent shall establish a standard appeal process which includes procedures for appeals to be filed in writing... View more
NY Ins L §4904(d)
August 8, 2021 3:11 pm(d) Both expedited and standard appeals shall only be conducted by clinical peer reviewers, provided that any such appeal shall be... View more
Ohio Rev Code §3901.381(B)(1)
October 15, 2021 5:36 am(B)(1) Unless division (B)(2) or (3) of this section applies, when a third-party payer receives from a provider or beneficiary... View more