RCW 48.43.600 (1-3)
January 22, 2025 12:51 am(1) Except in the case of fraud, or as provided in subsections (2) and (3) of this section, a carrier... View more
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RI Gen L § 27-18.9-6(a)(1-2)
October 15, 2021 5:26 am(1) For urgent or emergent healthcare services, benefit determinations (adverse or non-adverse) shall be made as soon as possible taking... View more
RI Gen L § 27-18.9-6(a)(3)
October 15, 2021 5:35 am(3) For pre-service claims (adverse or non-adverse), within a reasonable period of time appropriate to the medical circumstances, but not... View more
RI Gen L § 27-18.9-6(b)(2)
October 15, 2021 5:33 am(2) Notification content shall: (i) Be culturally and linguistically appropriate; (ii) Provide details of a claim that is being denied... View more
RI Gen L § 27-18.9-7(b)(3)(iii-iv)
October 15, 2021 5:34 am(iii) When the appeal of any adverse benefit determination, including an appeal of a reconsideration decision, is based in whole... View more
RI Gen L § 27-41-30.1(a)
October 15, 2021 5:34 am(a) Every individual or group hospital or medical services plan contract delivered, issued for delivery, or renewed in this state... View more
RI Gen L § 27-41-64(a)
October 15, 2021 5:26 am(a) A health care entity or health plan operating in the state shall pay all complete claims for covered health... View more
RI Gen L § 27-41-64(d)
October 15, 2021 5:34 am(d) A health care entity or health plan which fails to reimburse the health care provider or policyholder after receipt... View more
RI Gen L § 27-41-69(a)
October 15, 2021 5:32 am(a) Except as otherwise provided herein, any review, audit, or investigation by a health maintenance organization of a healthcare provider’s... View more
RI Gen L § 27-41-79(c)(1)
October 15, 2021 5:33 am(c) A health maintenance organization shall provide coverage for emergency services in the following manner: (1) Without the need for... View more