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Ama Policy

Fair Market Practices H-285.981

03/13/2019
Credentialing-Due Process-Denial of Contract, Profiling, U.R. Criteria
Ama Policy

Managed Care H-285.998

01/03/2022
State Medical Necessity Decisions-Deadlines, U.R. Criteria
Ama Policy

The Critical Role of Physicians in Health Plans and Integrated Delivery Systems H-285.931

03/13/2019
U.R. Criteria
Ama Policy

Approaches to Increase Payer Accountability H-320.968

03/05/2021
State Medical Necessity Decisions-Deadlines, U.R. Criteria
Ama Policy

Third Party Payer Coverage Process Reform and Advocacy D-185.986

03/13/2019
Amendments, U.R. Criteria
Ama Policy

Emerging Trends in Utilization Management H-320.958

03/13/2019
U.R. Criteria
Ama Policy

Medical Necessity Determinations H-320.995

03/13/2019
U.R. Criteria
Ama Policy

Medical Necessity and Utilization Review H-320.942

09/02/2022
U.R. Criteria
Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart E. Relationships with Providers

08/30/2023 42 CFR 422.202

Participation procedures

Amendments-Med. Adv., Termination-Due Process-Med. Adv., U.R. Criteria
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