Managedcarelegaldatabase.org

Definitions of “Screening” and “Medical Necessity” H-320.953

WebMedical Necessity-Definition. (1) Our AMA defines screening as: Health care services or products provided to an individual without apparent signs or symptoms of an …

Actived: 5 days ago

URL: https://managedcarelegaldatabase.org/ama-policy/definitions-of-screening-and-medical-necessity-h-320-953/

New Mexico Statutes Ann-Chapter 13-Article 7. Health Care …

Web07/21/2020 New Mexico Section 13-7-18 Prescription drug coverage; step therapy protocols; clinical review criteria; exceptions This entire law falls under the category “Step Therapy …

Category: Health Go Health

Code of Colorado Regs-3 CCR 702-4 Series 4-2

Web07/24/2023 Colorado Regulation 4-2-53 Network Adequacy Standards and Reporting Requirements for ACA-Compliant Health Benefit Plans Section 1 Authority This …

Category: Health Go Health

Self-funded Healthcare Plan Opt-in to the Surprise Billing …

Web08/02/2023 Georgia Sections 33-20F-1 through 33-20F-5 Definitions; Opt-in by ERISA self-funded plans; Departmental website; exemption; Powers of Commissioner Section 33 …

Category: Health Go Health

Colorado Rev. Statutes-Title 10-Article 16-Part 1. General Provisions

Web07/31/2023 Colorado Section 10-16-106.5 Prompt payment of claims–legislative declaration–rules See bold sections below: (1) The general assembly finds, determines, …

Category: Health Go Health

Maryland Statutes-Article 15. Insurance

Web07/18/2023 Maryland Section 15-10B-06 Requirements applicable to medical necessity decisions made by private review agents See bold sections below: (a)(1) Except as …

Category: Medical Go Health

Maryland Statutes-Article 15. Insurance

WebInsurance - Managed Care Contracting. State Law. Maryland Statutes-Article 15. Insurance. 08/07/2023 Maryland Section 15-112.2. Requirements and prohibitions …

Category: Health Go Health

The Insurance Company Law of 1921 (P.L.682, No.284)

WebOne of the following: (1) A person, including a health care provider, to whom a covered person or enrollee has given express written consent to represent the covered …

Category: Health Go Health

Rhode Island Gen Laws-Title 27-Chapter 27-18. Accident and …

Web08/22/2023 Rhode Island Section 27-18-76 Emergency services (a) As used in this section: (1) “Emergency medical condition” means a medical condition manifesting itself by acute …

Category: Medical Go Health

Oklahoma Statutes. Title 36. Insurance

Web08/18/2023 Oklahoma Section 6907 Reasonable standards of quality of care – Quality assurance plan and activities – Record of proceedings – Patient record system – Medical …

Category: Medical Go Health

Illinois Compiled Statutes-215 ILCS 200. Prior Authorization …

WebThis Act may be cited as the Prior Authorization Reform Act. Section 5. Purpose. The General Assembly hereby finds and declares that: (1) the health care …

Category: Health Go Health

Illinois Compiled Statutes-Insurance-215 ILCS 105/ …

Web08/03/2023 Illinois Section 105/2 Definitions See bold text below: As used in this Act, unless the context otherwise requires: “Plan administrator” means the insurer or third party …

Category: Health Go Health

The Laws Of New York-Consolidated Laws-Insurance. Article 48.

Web08/16/2023 New York Section 4803 Health care professional applications and terminations See bold text below: Credentialing-Deadlines (a) (1) An insurer which offers a managed …

Category: Health Go Health

Minnesota Statutes-Chapter 62M. Utilization Review of Health Care

Web08/08/2023 Minnesota Section 62M.02 Definitions See bold text below: Subdivision 1. Terms. For the purposes of sections this chapter, the terms defined in this section have …

Category: Health Go Health

Tennessee Code-Title 68-Chapter 11-Part 2. Regulation of Health …

Web08/24/2023 Tennessee Section 68-11-243 Collection of out-of-network charges by healthcare facility (a) For the purposes of this section: (1) “Emergency medical services” …

Category: Medical Go Health

Arkansas Insurance Department-Rule and Regulation 43

Web1. Purpose. The purpose of this rule is to define certain minimum standards which, if violated with such frequency as to indicate a general business practice, will be …

Category: Health Go Health

Maryland Statutes-Article 14. Insurance

Web08/08/2023 Maryland Sections 14-201 & 14-205.2 Definitions applicable to Section 14-205.2; Determining amounts payable to certain out-of-network physicians Section 14 …

Category: Health Go Health

West Virginia Ins Commission- Utilization Review and Benefit

Web08/28/2023 West Virginia Section 114-95-2 Definitions See bold text below: 2.1. “Adverse determination” means a determination by an issuer or its designee utilization review …

Category: Health Go Health