Search Results

Federal Law

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

08/30/2023 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

08/30/2023 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

08/30/2023 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

08/29/2023
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
Federal Law

Title 26-Internal Revenue-Chapter I-Subchapter D-Part 54. Pension Excise Taxes

08/30/2023 26 CFR Sections 54.9815-2719 and 54.9815-2719T

Internal claims and appeals and external review processes; Internal claims and appeals and external review processes (temporary)

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

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

08/01/2023 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

08/15/2023 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

08/15/2023 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

08/25/2023 Utah Section R590-203-5

Adverse Benefit Determination

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