Ensures the decision to downcode an insurance claim is recognized as an adverse determination; prohibits health plans from reversing or altering medical necessity determinations made by a utilization review agent or external appeals agent as a result of an audit of claims.
Same As
Ensures the decision to downcode an insurance claim is recognized as an adverse determination; prohibits health plans from reversing or altering medical necessity determinations made by a utilization review agent or external appeals agent as a result of an audit of claims.
Ensures the decision to downcode an insurance claim is recognized as an adverse determination; prohibits health plans from reversing or altering medical necessity determinations made by a utilization review agent or external appeals agent as a result of an audit of claims.
Requires written notice of an adverse determination made by a utilization review agent in relation to a step therapy protocol override determination which includes the clinical review criteria relied upon to make such determination and any applicable alternative prescription drugs subject to the step therapy protocol of the utilization review agent.
Requires written notice of an adverse determination made by a utilization review agent in relation to a step therapy protocol override determination which includes the clinical review criteria relied upon to make such determination and any applicable alternative prescription drugs subject to the step therapy protocol of the utilization review agent.
Requires that notice of initial determinations for unemployment benefits be provided to claimants within 30 days of such claimant furnishing all necessary documentation, and if the commissioner is unable to issue a determination within such time frame they shall inform the claimant of the new estimated time frame for the issuance of a determination.
Requires that notice of initial determinations for unemployment benefits be provided to claimants within 30 days of such claimant furnishing all necessary documentation, and if the commissioner is unable to issue a determination within such time frame they shall inform the claimant of the new estimated time frame for the issuance of a determination.
Provides that the failure by the utilization review agent to make a determination within certain time periods shall be deemed to be an approval of the health care services.
Provides that the failure by the utilization review agent to make a determination within certain time periods shall be deemed to be an approval of the health care services.
Prohibits the appointment of certain state, municipal or agency employees as impartial hearing officers to hear appeals of determinations regarding children with handicapping conditions.