Search Results

Federal Law

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

08/15/2020 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 ยง 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

Prior Authorization Requirements for Post-Operative Opioids: H-95.919

10/14/2019
ERISA-Med. Nec. Decisions-Deadlines, Med. Adv.-Med. Nec. Appeals-Deadlines, Step Therapy Override
Ama Policy

Private Health Insurance Formulary Transparency H-125.979

10/14/2019
ERISA-Med. Nec. Decisions-Deadlines, Med. Adv.-Med. Nec. Decisions-Deadlines, State Medical Necessity Decisions-Deadlines
Ama Policy

Promoting Accountability in Prior Authorization D-320.983

10/14/2019
ERISA-Med. Nec. Decisions-Deadlines, State Medical Necessity Decisions-Deadlines
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

KY. Rev. Statutes-Chapter 304-Subtitle 17A-Health Benefit Plans-Utilization Reviews

07/01/2020 Kentucky Section 304.17A-607

Duties of insurer or private review agent performing utilization reviews — Requirement for registration — Consequences of insurer’s failure to make timely utilization review determination — Requirement that insurer or private review agent submit changes to the department — Requirement that private review agent provide timely notice of entities for whom it is providing review.

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