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Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart M. Grievances, Organization Determinations and Appeals

08/30/2023 42 CFR 422.619

How an MA organization must effectuate expedited reconsidered determinations

Med. Adv.-Med. Nec. Appeals-Deadlines
Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart M. Grievances, Organization Determinations and Appeals

08/30/2023 42 CFR 422.618

How an MA organization must effectuate standard reconsidered determinations or decisions.

Med. Adv.-Med. Nec. Appeals-Deadlines, Prompt Payment Deadlines-Med. Adv.
Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart M. Grievances, Organization Determinations and Appeals

08/30/2023 42 CFR 422.590

Timeframes and responsibility for reconsiderations

Med. Adv.-Med. Nec. Appeals-Deadlines
Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart M. Grievances, Organization Determinations and Appeals

08/30/2023 42 CFR 422.584

Expediting certain reconsiderations

Anti-retaliation-Med. Adv., Med. Adv.-Med. Nec. Appeals-Deadlines
Federal Law

Title 42-Chapter 7-Subchapter XVIII-Part C. Medicare+Choice Program

08/30/2023 42 USC Section 1395w-22

Benefits and beneficiary protections

Anti-gag clause-Med. Adv., Directories-Med. Adv., Liability-insurer shifting to physician-Med. Adv., Med. Adv.-Med. Nec. Appeals-Deadlines, Med. Adv.-Med. Nec. Decisions-Deadlines, Network Adequacy-Med. Adv., Prohibited financial incentives-Med. Adv., Risk-Physicians Taking-Med. Adv.
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