The purpose of this regulation is to reflect changes to bring the Benefit Determination and Utilization Review Act to current national protective standards to assure that benefit determination agencies maintain timely approval and payment for covered health care services to health care entity beneficiaries. In addition, it provides clarity for in these regulations assure quality, […]
Administrative Letter 2019-02 was issued to provide guidance for the submission of complaint system filings, notice and policy form requirements to comply with the provisions of Chapter 826 (House Bill 1915) and Chapter 840 (Senate Bill 1161) enacted by the General Assembly during its 2019 legislative session. To view the Administrative Letter, please click here.
Sections 38.2-3559 through 38.2-3562 of the Code of Virginia relating to health carriers, expedited reviews of adverse coverage determinations, exhaustion of internal reviews and cancer patients was enacted on April 3, 2019. To view the enacted bills, please click here.
Section 4530.40 has been amended to make the deadline for health carriers to submit an external review report to the Director of Insurance consistent with PA 99-537, which became effective January 1, 2017. To view the amendment, click here.
The New Jersey Department of Banking and Insurance, Division of Insurance, Consumer Protection Services, Office of Managed Care, issued its semi-annual report to the Legislature on activities related to the Independent Health Care Appeals Program from January 1, 2018 through June 30, 2018. To view the report, click here.
On September 11, 2018, the Insurance Division issued Bulletin B 18-13. The bulletin stated that the Alaska Division of Insurance will resume oversight of the external review process on October 1, 2018. To view this bulletin, click here.
Pursuant to Alaska Register 225, changes to 3 AAC 28.900 – 3 AAC 28.918 (Utilization Review and Benefit Determinations), 3 AAC 28.930 – 3 AAC 28.938 (Health Care Insurer Grievance Procedure), 3 AAC 28.950 – 3 AAC 28.982 (External Review of Health Care Coverage Decisions), and 3 AAC 28.989 (General Provisions: Utilization and Benefit Determination, […]