Search Results

Ama Policy

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

03/13/2019
Medical Necessity-Definition
ARC Advocacy Resources

Prior Authorization Model Bill

Addresses the burden of prior authorizations on patients and physicians by increasing the transparency in prior authorization requirements, ensuring that payers respond to requests in a timely manner and preventing retroactive denials of authorizations.

Medical Necessity-Definition, Model Legislation, Retroactive Denial, State Medical Necessity Decisions-Deadlines, U.R. Criteria
State Law

Arizona Rev. Statutes-Title 20-Chapter 26-Article 1. General Provisions

09/28/2021 Arizona Section 20-3401

Definitions

Medical Necessity-Definition
State Law

Arkansas Code-Title 23-Subtitle 3-Chapter 99-Subchapter 11. Prior Authorization Transparency Act

12/20/2019 Arkansas Section 23-99-1103

Definitions

Medical Necessity-Definition, U.R. Criteria
State Law

California Code of Regulations-Title 10-Chapter 5-Subchapter 2-Article 1.4. Standard Prescription Drug Formulary Template

08/24/2020 California Section 2218.82

Standard Prescription Drug Formulary Template

Medical Necessity-Definition, Step Therapy Override
State Law

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

08/18/2020 Colorado Section 10-16-112.5

Prior authorization for health care services – disclosures and notice – determination deadlines – criteria – limits and exceptions – definitions – rules

Medical Necessity-Definition, Retroactive Denial, State Medical Necessity Decisions-Deadlines, U.R. Criteria
State Law

General Statutes of Connecticut-Title 38a-Chapter 700c. Health Insurance

08/17/2020 Connecticut Section 38a-513c

Group health insurance policy to contain definition of “medically necessary” or “medical necessity”

Medical Necessity-Definition
State Law

Delaware Code-Title 18-Chapter 35-Subchapter V. Pre-Authorization Transparency

06/22/2020 Delaware Section 3581

Definitions

Medical Necessity-Definition, Step Therapy Override, U.R. Criteria
State Law

Title 18. Insurance-1300-1301. Internal Review and Independent Utilization Review of Health Insurance Claims

06/22/2020 Delaware Part 1301 (Sections 1.0-14.0)

Internal Review and Independent Utilization Review of Health Insurance Claims

Anti-retaliation, Medical Necessity-Definition
State Law

Title 18. Insurance Code-Chapter 33. Health Insurance Contracts-Subchapter II. Pre-Authorization Transparency

06/22/2020 Delaware Section 3371

Definitions

Medical Necessity-Definition, U.R. Criteria