State Laws

Search state statutes and regulations in all 50 states and the District of Columbia to find out what rights you have in your state and what other states are doing to empower physicians and patients in the face of health insurer market power.

State Law

Indiana Code-Title 27-Article 1-Chapter 37.6. Program to Reduce or Eliminate Prior Authorization Requirements for Health Care Providers

07/14/2023 Indiana Sections 27-1-37.6.1 through 27-1-37.6.18

Chapter 37.6. Program to Reduce or Eliminate Prior Authorization Requirements for Health Care Providers

Payment Edits, Risk—Physicians Taking
State Law

Indiana Code-Title 27-Article 13-HMOs-Chapter 36.2. Provider Payment

07/13/2023 Indiana Sections 27-13-36.2-1, 27-13-36.2-3, 27-13-36.2-4, 27-13-36.2-4.5, 27-13-36.2-6; 27-13-36.2-8; 27-13-36.2-9

“Clean Claim” Defined; Notice of Deficiencies in Claims; Payment or Denial of Claims, Interest; Limitations on an Insurer’s Ability to Alter CPT Code or Pay for a CPT Code of Lesser Monetary Value; Civil Penalties; Claim Payment Errors; Claim Overpayment Adjustment

Payment Edits, Prompt Payment Deadlines
State Law

Indiana Code-Title 27-Article 8-Chapter 5.7-Accident and Sickness Insurance; Provider Payment

07/12/2023 Indiana Sections 27-8-5.7-2, 27-8-5.7-2.5, 27-8-5.7-3, 27-8-5.7-5, 27-8-5.7-6, 27-8-5.7-6.5, 27-8-5.7-8, 27-8-5.7-10, 27-8-5.7-11

“Clean Claim” Defined; “CPT Code” Defined; “Insurer” Defined; Notice of Deficiencies in Claims; Payment or Denial of Claims, Interest; Limitations on an insurer’s ability to alter CPT code or pay for a CPT code of lesser monetary value; Civil Penalties; Claim Payment Errors; Claim Overpayment Adjustment

Overpayments / Recoupments, Payment Edits, Prompt Payment Deadlines
Ama Policy

Fair Reimbursement for Administrative Burdens D-320.978

09/02/2022
Payment Edits, U.R. Criteria
State Law

Maryland Statutes-Article 15. Insurance

08/07/2023 Maryland Section 15-113

Health Insurance – Two–Sided Incentive Arrangements

Amendments, Fee Schedules, Overpayments / Recoupments, Participation in Products, Plans, or Networks, Payment Edits, Payment Rules, Prohibited financial incentives, Prompt Payment Deadlines, Risk—Physicians Taking
Ama Policy

Improper Use of AMA-CPT by Carriers/Software Programs H-70.954

01/03/2022
Fee Schedules, Payment Edits
State Law

New Jersey Statutes-Title 17B. Insurance

08/19/2023 New Jersey Section 17B:30-51

Information required from payer

Payment Edits
State Law

Illinois Compiled Statutes-215 ILCS 5/-Illinois Ins. Code-Article XX. Accident and Health Insurance

08/03/2023 Illinois Section 5/368g

Time-based billing

Payment Edits