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Ama Policy

Third Party Responsibility for Payment H-185.981

03/13/2019
Retroactive Denial
Ama Policy

Physicians’ Experiences with Retrospective Denial of Payment and Down-Coding by Managed Care Plans D-320.995

08/31/2022
Retroactive Denial
Ama Policy

Physicians’ Experiences with Retrospective Denial of Payment and Down-Coding by Managed Care Plans H-320.948

12/30/2021
Retroactive Denial
Ama Policy

Prior Authorization Relief in Medicare Advantage Plans H-320.938

09/02/2022
Amendments, Retroactive Denial
Ama Policy

Preauthorization for Payment of Services H-320.961

09/02/2022
Retroactive Denial
Ama Policy

Denials of Payment for Necessary Services Because of Lack of Authorization H-285.940

10/15/2019
Retroactive Denial
Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart C. Benefits and Beneficiary Protections

11/20/2024 42 CFR Section 422.138

Prior authorization

Retroactive Denial
State Law

Code of Alabama 1975-Title 27-Chapter 1. General Provisions

07/27/2023 Alabama Section 27-1-17

Limitation periods for payment of claims; overdue claims; retroactive denials, adjustments, etc.; penalties.

Claims Filing Deadlines, Overpayments / Recoupments, Prompt Payment Deadlines, Retroactive Denial
State Law

Alaska Statutes-Title 21-Chapter 07. Patient Protections Under Health Care Insurance Policies

07/27/2023 Alaska Section 21.07.020

Required contract provisions for health care insurance policy

Retroactive Denial
State Law

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

07/27/2023 Alaska Section 28.910

Procedures for standard utilization review and benefit determinations

Retroactive Denial, State Medical Necessity Decisions-Deadlines