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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
Ama Policy

Excessive Telephone Wait Times for Physician Appeals of Managed Care Decisions on Patient Care D-285.977

10/15/2019
State Medical Necessity Appeals-Deadlines
Ama Policy

Notification, Precertification, and Appeals for Medications and Imaging Studies D-320.992

10/15/2019
State Medical Necessity Appeals-Deadlines
State Law

Code of Alabama 1975-Title 27-Chapter 3A. Health Care Service Utilization Review Act

07/27/2023 Alabama Section 27-3A-5

Standards for utilization review agents

State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines
State Law

Alaska Admin. Code-Title 3-Chapter 28-Article 10. Utilization Review and Benefit Determinations

07/27/2023 Alaska Section 28.936

Reviews of grievances involving an adverse determination

State Medical Necessity Appeals-Deadlines
State Law

Alaska Admin. Code-Title 3-Chapter 28-Article 10. Utilization Review and Benefit Determinations

07/27/2023 Alaska Section 28.938

Expedited reviews of grievances involving an adverse determination

State Medical Necessity Appeals-Deadlines
State Law

Ariz. Rev. Statutes-Title 20. Insurance-Chapter 15-Article 2. Health Care Appeals

07/28/2023 Arizona Section 20-2534

Expedited medical review; expedited appeal

State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines
State Law

Ariz. Rev. Statutes-Title 20. Insurance-Chapter 15-Article 2. Health Care Appeals

07/28/2023 Arizona Section 20-2536

Formal appeal

State Medical Necessity Appeals-Deadlines
State Law

Code of Colorado Regs-3 CCR 702-4 Series 4-2

07/29/2023 Colorado Regulation 4-2-17

Prompt investigation of health claims involving utilization review and denial of benefits and rules related to internal claims and appeals processes

State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines
State Law

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

07/29/2023 Connecticut Section 38a-591e

Internal grievance process of adverse determinations based on medical necessity. Expedited review of adverse determinations of urgent care requests.

State Medical Necessity Appeals-Deadlines