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.
Requirements relating to basic benefits
Definitions; Clinical Decisions; Carrier’s Medical Necessity Guidelines; Time Limits for Resolution of Non-expedited Internal Grievances; Review of Internal Grievances; Expedited Internal Review of Adverse Determinations; Additional Requirements for Expedited Internal Review; Failure of Carrier to Meet Time Limits
See the text for the various section titles.
Application; Legislative Purposes and Intent; Definitions
Definitions
Act, how cited; Definitions, where found;Covered person, defined;Emergency medical condition, defined;Emergency services, defined;Health benefits plan, defined; Health care facility, defined; Health care professional, defined; Health care provider, defined; Insurer, defined; Medical assistance program, defined; Medically necessary, defined; TRICARE, defined
Definitions
Prescription drug utilization management — Definitions
Step therapy