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Federal Laws

Find out what rights you and your patients have under current federal statutes and regulations, such as the Employee Retirement Income Security Act and the Medicare Advantage program.

To search for an exact phrase, you should enclose the entire phrase in quotation marks. For example, "patient care".
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Payment Issues

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Claims Processing

Federal Law

Title 26-Internal Revenue-Chapter I-Subchapter D-Part 54. Pension Excise Taxes

08/30/2023 26 CFR Sections 54.9815-2719 and 54.9815-2719T

Internal claims and appeals and external review processes; Internal claims and appeals and external review processes (temporary)

ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines
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
Federal Law

Title 29. Labor-Subtitle B-Chapter XXV-Subchapter G-Part 2560-Rules And Regulations For Administration And Enforcement

08/30/2023 29 CFR 2560.503-1

Claims Procedure

ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines, Preemption-ERISA
Federal Law

Title 42- Chapter 6A-Requirements Relating to Health Insurance Coverage-Individual and Group Market Reforms

08/30/2023 42 USC Section 300gg-19

Appeals process

ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines
Federal Law

Title 45-Subtitle A-Subchapter B-Part 147. Health Insurance Reform Requirements for the Group and Individual Health Insurance Markets

08/30/2023 45 CFR 147.136

Internal claims and appeals and external review processes

ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines
State Law

Utah Admin Code-Title R590-Rule R590-203. Health Grievance Review Process

08/25/2023 Utah Section R590-203-5

Adverse Benefit Determination

ERISA-Med. Nec. Appeals-Deadlines, Medical Necessity-Definition, State Medical Necessity Appeals-Deadlines
State Law

North Dakota Century Code-Title 26.1-Chapter. 26.1-26.4. Health Care Service Utilization Review

08/15/2023 North Dakota Section 26.1-26.4-04

Minimum standards of utilization review agents

ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines
State Law

North Dakota Century Code-Title 26.1-Chapter. 26.1-36. Accident and Health Insurance

08/15/2023 North Dakota Section 26.1-36-47

Internal claims and appeals procedures

ERISA-Med. Nec. Appeals-Deadlines, ERISA-Med. Nec. Decisions-Deadlines, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines
State Law

Title XXXVII-Insurance-Chapter 641-Part III. Health Care Services

08/01/2023 Florida Section 641.511

Subscriber grievance reporting and resolution requirements.

ERISA-Med. Nec. Appeals-Deadlines, State Medical Necessity Appeals-Deadlines