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Section 1 - Definitions - Section 1. As used in this chapter, the following words...
Section 2 - Bureau of Managed Care - Section 2. (a) There is hereby established within the division...
Section 3 - Complaints Against Carriers; Notice; Hearing - Section 3. (a) The bureau shall investigate all complaints made...
Section 4 - Refusal of Carriers to Contract With Eligible Health, Dental or Vision Care Providers Solely Because Providers Have Practiced Good Faith Advocacy on Behalf of Patients - Section 4. A carrier, including a dental or vision carrier,...
Section 5 - Contracts; Liability - Section 5. No contract between a carrier, including a dental...
Section 5a - Acceptance and Recognition of Information Submitted Pursuant to Current Coding Standards and Guidelines Required; Use of Standardized Claim Formats - Section 5A. (a) Subject to subsection (c), for the purposes...
Section 5b - Policies and Procedures to Enforce Sec. 5a - Section 5B. To ensure uniformity and consistency in the submission...
Section 5c - Failure of Carrier to Comply With Coding Standards and Guidelines; Notice; Penalty - Section 5C. If the commissioner determines that a carrier is...
Section 6 - Evidence of Coverage to Be Delivered to Covered Adults by Health, Dental and Vision Care Providers; Contents - Section 6. (a) A carrier shall issue and deliver to...
Section 7 - Information Provided by Carrier Upon Enrollment or Upon Request - Section 7. (a) A carrier shall provide to at least...
Section 8 - Failure by Carrier to File Annual Statement; Fine - Section 8. A carrier neglecting to make and file its...
Section 9 - Utilization Review Programs; Annual Attestations - Section 9. A carrier shall annually provide a written attestation...
Section 9a - Agreements or Contracts Between Carrier and Health Care Provider Prohibited if Containing Certain Provisions - Section 9A. A carrier shall not enter into an agreement...
Section 9b - Alternate Payment Arrangements Involving Downside Risk Prohibited Without Risk Certificate - Section 9B. Carriers shall not be permitted to enter into...
Section 10 - Contractual Financial Incentive Plans - Section 10. (a) No contract between a carrier, including a...
Section 11 - Rights of Health Benefit Plans to Include as Providers Religious Non-Medical Providers - Section 11. Nothing in this chapter shall be construed to...
Section 12 - Utilization Review - Section 12. (a) Utilization review conducted by a carrier or...
Section 13 - Formal Internal Grievance Process; Expedited Resolution Policy - Section 13. (a) A carrier or utilization review organization shall...
Section 14 - Review Panel; Patient Protection Office - Section 14. (a) An insured who remains aggrieved by an...
Section 15 - Disenrollment of Provider; Continuation of Treatment; Specialty Health Care Coverage - Section 15. (a) A carrier that allows or requires the...
Section 16 - Clinical Decisions Regarding Medical Treatment Made by Treating Physicians; Payment for Health Care Services Ordered by Treating Physician or Primary Care Provider - Section 16. (a) The physician treating an insured, shall, consistent...
Section 17 - Regulations; Promulgation - Section 17. The commissioner shall promulgate regulations to enforce sections...
Section 18 - Responsibility of Carrier for Behavioral Health Services Compliance - Section 18. A carrier for whom a behavioral health manager...
Section 19 - Display of Name and Telephone Number of Health Service Manager on Enrollment Cards of Carrier - Section 19. A carrier for whom a behavioral health manager...
Section 20 - Information Provided to Insured Adults by Behavioral Health Manager; Submission of Material Changes; Workers' Compensation; Preferred Provider Arrangements - Section 20. (a) A behavioral health manager shall provide the...
Section 21 - Submission by Carrier of Annual Comprehensive Financial Statement - Section 21. [There is no subsection (a).] (b)(1) In this...
Section 22 - Participation in Medical Assistance Program as Condition for Participation in Carrier's Provider Network - Section 22. Notwithstanding any other general or special law to...
Section 23 - Disclosure by Carrier Upon Request for Network Status of Health Care Provider and Estimated or Maximum Allowed Amount or Charge for a Proposed Admission, Procedure or Service and Amount Insured Responsible to Pay; Establishment of Toll-F... - Section 23. All carriers shall establish a toll-free telephone number...
Section 24 - Internal Appeals Processes for Risk-Bearing Provider Organizations; Patient's Right to Third-Party Advocate; External Review Process - Section 24. (a) All risk-bearing provider organizations certified under chapter...
Section 25 - Use and Acceptance of Specifically Designated Prior Authorization Forms - Section 25. (a) A payer or any entity acting for...
Section 26 - Establishment of Standardized Processes and Procedures for the Determination of Patient's Health Benefit Plan Eligibility at or Prior to Time of Service - Section 26. The commissioner shall establish standardized processes and procedures...
Section 27 - Development and Use of Common Summary of Payments Form; Implementation of Education Plan - [Text of section applicable as provided by 2018, 63, Sec....
Section 28 - Provider Directories; Contents; Audits; Print Copies; Customer Service Contact Information; Accommodations; Accuracy; Updates - Section 28. (a) A carrier shall ensure the accuracy of...
Section 29 - Health Care Provider Credentialing - Section 29. (a) The bureau of managed care shall develop...