Statutory and regulatory selections in context. In most cases, statutes and regulations in the Database are subsections of larger statutory or regulatory chapters or sections. For example, the Database includes section 28.910 of the Alaska Administrative Code entitled “Procedures for standard utilization review and benefit determinations” organized under the Database Tags “Retroactive Denial” and “State Medical Necessity Decisions-Denials.” Section 28.910 is just one section under Alaska Administrative Code Title 3, Article 10 “Utilization Review and Benefit Determinations.” Users of the Database are encouraged to refer to the overall statutory or regulatory sections of which specific statutes and regulations in the Database are a part for further research or to understand the overall context in which selected Database statutes and regulations are placed. The Database does not include the most recent version of the relevant statutes or regulation in every jurisdiction and court decisions may affect the interpretation and constitutionality of statues and regulations. As such, users should check with official sources and consult with legal counsel to verify whether the statutory or regulatory provisions of interest have been modified or revised before relying upon them.
Use of “Tags” and formatting. The Database’s statutes and regulations have been selected because they contain language addressing managed care issues about which physicians or often concerned. The relevant issues are identified under Tags that the Database employs. Currently the Database uses 54 Tags, ranging from Fee Schedules to prompt payment deadlines applicable to Medicare Advantage, (Prompt Payment Deadlines-Med. Adv). These 54 Tags are organized under five general categories, i.e., Payment Issues, Network Issues, Contract Changes/Disputes, Coverage/Utilization Review, and Claims Processing. To aid Database users, frequently the portion of the state or regulation relevant to the particular Tag or Tags is identified in Bold, and under a Bold Heading that corresponds to the relevant Tag or Tags. For example, section 10-16-112.5 of Colorado Revised Statutes is included in the Database under the following tags: Medical Necessity-Definition; Retroactive Denial; State Medical Necessity Decisions-Deadlines; and U.R. Criteria. Section 10-16-112.5(4)(a)(I) is in bold, under a bold heading “U.R. Criteria,” because that language addresses issues falling under the tag entitled “U.R. Criteria.” The headings and bold formatting have been added by the AMA and are not a part of the statutes or regulations themselves. The AMA makes no warranty, guarantee, or promise, express or implied, concerning the use of formatting, the application of Tags, or whether the AMA has identified all of the statutes and regulations of all fifty states and the federal government that contain language relevant to the Databases Tags—given the vast number of state and federal statutes and regulations involved, it is likely that the Database does not capture all relevant statutes and regulations.