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Federal Law

Title 45-Subtitle A-Subchapter B-Part 147. Health Insurance Reform Requirements for the Group and Individual Health Insurance Markets

08/15/2020 45 CFR 147.136

Internal claims and appeals and external review processes

ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines
Federal Law

Title 42- Chapter 6A-Requirements Relating to Health Insurance Coverage-Individual and Group Market Reforms

12/08/2020 42 USC Section 300gg-19

Appeals process

ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines
Federal Law

Title 29. Labor-Subtitle B-Chapter XXV-Subchapter G-Part 2560-Rules And Regulations For Administration And Enforcement

04/25/2019 29 CFR 2560.503-1

Claims Procedure

ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines, Preemption-ERISA
Ama Policy

Third Party Payer Quantity Limits H-185.942

10/15/2019
ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines, Step Therapy Override, U.R. Criteria
State Law

Title XXXVII-Insurance-Chapter 641-Part III. Health Care Services

06/23/2020 Florida Section 641.511

Subscriber grievance reporting and resolution requirements.

ERISA-Med. Nec. Appeals-Deadlines, State Medical Necessity Appeals-Deadlines
State Law

North Dakota Century Code-Title 26.1-Chapter. 26.1-36. Accident and Health Insurance

07/23/2020 North Dakota Section 26.1-36-47

Internal claims and appeals procedures

ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines
State Law

North Dakota Century Code-Title 26.1-Chapter. 26.1-26.4. Health Care Service Utilization Review

07/23/2020 North Dakota Section 26.1-26.4-04

Minimum standards of utilization review agents

ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines
State Law

Utah Admin Code-Title R590-Rule R590-203. Health Grievance Review Process

08/26/2022 Utah Section R590-203-5

Adverse Benefit Determination

ERISA-Med. Nec. Appeals-Deadlines, State Medical Necessity Appeals-Deadlines