40 P.S §991.2166(b)
October 15, 2021 5:46 am(b) If a licensed insurer or a managed care plan fails to remit the payment as provided under subsection (a),... View more
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40 PA.C.S §3803(a-b)
October 15, 2021 5:44 am(a) General rule.–Except as provided in section 3804 (relating to exceptions to retroactive denial of reimbursement), an insurer may not... View more
42 CFR § 422.113(c)(2-3)
May 23, 2020 4:16 pm(2) The MA organization – (i) Is financially responsible (consistent with Sec. 422.214) for post-stabilization care services obtained within or... View more
42 CFR § 422.216(a)(3-4)
May 23, 2020 4:19 pm(3) Noncontract providers. The organization pays for services of noncontract providers in accordance with Sec. 422.100(b)(2). (4) Service furnished by... View more
42 CFR § 422.520
May 23, 2020 4:17 pm(a) Contract between CMS and the MA organization. (1) The contract between CMS and the MA organization must provide that... View more
42 CFR § 422.520(b)(1-2)
May 23, 2020 4:20 pm(1) Contracts between MA organizations and providers and suppliers. Contracts or other written agreements between MA organization and providers must... View more
42 CFR § 424.44(a)(1)
May 23, 2020 4:18 pmExcept as provided in paragraphs (b) and (e) of this section, for services furnished on or after January 1, 2010,... View more
42 CFR §422.101(b)
September 5, 2020 4:54 pm(b) Comply with – (1) CMS’s national coverage determinations; (2) General coverage guidelines included in original Medicare manuals and instructions... View more
42 CFR §422.113(b)
May 23, 2020 3:27 pm(2) MA organization financial responsibility. The MA organization is financially responsible for emergency and urgently needed services— (i) Regardless of... View more
42 CFR §422.113(c)(2)
May 23, 2020 3:39 pm(iii) Is financially responsible for post-stabilization care services obtained within or outside the MA organization that are not pre-approved by... View more