Search Results

Ama Policy

Fair Market Practices H-285.981

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

Qualifications and Credentialing of Physicians Involved in Managed Care H-285.991

03/13/2019
Credentialing-Due Process-Denial of Contract, Termination, Termination-Due Process
Ama Policy

Managed Care Consensus Bill H-285.941

03/13/2019
Credentialing-Due Process-Denial of Contract, Termination-Due Process
Ama Policy

Rescinding Provisions Requiring Physicians to Have Hospital Admitting Privileges D-180.994

10/15/2019
Credentialing-Due Process-Denial of Contract
Ama Policy

Discrimination Against Physicians by Health Care Plans H-285.985

10/15/2019
Credentialing-Due Process-Denial of Contract
State Law

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

07/11/2023 Arkansas Section 23-99-1120 (Gold Card Law)

Initial exemption from prior authorization requirements for healthcare providers providing certain healthcare services; Duration of prior authorization exemption; Denial or rescission of prior authorization exemption; Independent review of exemption determination; Effect of appeal of independent review organization determination; Eligibility for prior authorization exemption following
finalized exemption rescission or denial; Effect of prior authorization exemption; Applicability; Prescription drugs, medicines, biological products, pharmaceuticals, or pharmaceutical services; Appeals process for disallowance of prior authorization

Credentialing-Due Process-Denial of Contract
State Law

Maine Rev. Statutes-Title 24-A, Chapter 56-A, Subchapter 1. Health Plan Requirements

01/21/2025 Maine Section 4303

Plan requirements

Amendments, Anti-gag clause, Anti-retaliation, Continuity of Care Post-Contract, Credentialing-Deadlines, Credentialing-Due Process-Denial of Contract, Credentialing-Payment Issues, Fee Schedules, Most Favored Nation, Overpayments / Recoupments, Participation in Products, Plans, or Networks, Prohibited financial incentives, Retroactive Denial, Termination, Termination-Due Process
State Law

Dept. of Prof. & Fin. Regulation-Chapter 850-Health Plan Accountability

08/07/2023 Maine Sections 1-10

Purpose; Authority; Applicability and Scope; Affordable Care Act; Definitions; Quality Assurance Standards; Access to Services; Adverse Health Care Treatment Decisions; Grievance Register and Grievance Procedures; Reporting Requirements; Effective Date

Credentialing-Deadlines, Credentialing-Due Process-Denial of Contract, Network Adequacy, Retroactive Denial, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines, U.R. Criteria
State Law

Michigan Compiled Laws-Chapter 500. Insurance Code of 1956-Chapter 35. Health Maintenance Organizations

03/20/2021 Michigan Section 500.3531

Contracts with health care providers to become affiliated providers; requirements; standards; filing; duplicative standards; notice procedures; provider application period; approval or rejection as affiliated provider; termination of contract; providing information to insurer.

Credentialing-Due Process-Denial of Contract
State Law

Nebraska Rev. Statutes-Chapter 44. Insurance

08/10/2023 Nebraska Section 44-4109.01

Policies or contracts; requirements

Credentialing-Due Process-Denial of Contract, Credentialing-Patient Demographics, Termination-Due Process