America's Affordable Health Choices Act of 2009, October 14, 2009, 111-1 House Report 111-299, Part 1, *2009 |
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Страница 13
... claims payment policies and practices , periodic financial disclosure , data on enrollment , data on disenrollment , data on the number of claims denials , data on rating practices , information on cost - sharing and payments with ...
... claims payment policies and practices , periodic financial disclosure , data on enrollment , data on disenrollment , data on the number of claims denials , data on rating practices , information on cost - sharing and payments with ...
Страница 14
... CLAIMS . A QHBP offering entity shall comply with the requirements of section 1857 ( f ) of the Social Security Act with respect to a qualified health benefits plan it offers in the same manner an Medicare Advantage organization is ...
... CLAIMS . A QHBP offering entity shall comply with the requirements of section 1857 ( f ) of the Social Security Act with respect to a qualified health benefits plan it offers in the same manner an Medicare Advantage organization is ...
Страница 16
... CLAIMS DENIALS . - Such a program shall pro- vide for an evaluation of the clinical appropriateness of at least a sample of denials of claims for benefits . ( c ) CONDUCT OF PROGRAM ACTIVITIES.- ( 1 ) ADMINISTRATION BY HEALTH CARE ...
... CLAIMS DENIALS . - Such a program shall pro- vide for an evaluation of the clinical appropriateness of at least a sample of denials of claims for benefits . ( c ) CONDUCT OF PROGRAM ACTIVITIES.- ( 1 ) ADMINISTRATION BY HEALTH CARE ...
Страница 17
... claim as of the date of the deadline . ( e ) NOTICE OF DENIALS OF CLAIMS FOR BENEFITS.— ( 1 ) IN GENERAL . - Notice of a denial of claims for benefits under a utilization review program shall be provided in printed form and written in a ...
... claim as of the date of the deadline . ( e ) NOTICE OF DENIALS OF CLAIMS FOR BENEFITS.— ( 1 ) IN GENERAL . - Notice of a denial of claims for benefits under a utilization review program shall be provided in printed form and written in a ...
Страница 18
( 2 ) DENIAL OF CLAIM FOR BENEFITS . - The term " denial " means , with respect to a claim for benefits , means a denial , or a failure to act on a timely basis upon , in whole or in part , the claim for benefits and includes a failure ...
( 2 ) DENIAL OF CLAIM FOR BENEFITS . - The term " denial " means , with respect to a claim for benefits , means a denial , or a failure to act on a timely basis upon , in whole or in part , the claim for benefits and includes a failure ...
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111TH CONGRESS administrative Advisory agencies amount applicable appropriate areas assistance authorized Center clause clinical Commissioner Committee Congress contract coordination cost-sharing costs coverage Current Law dual eligibles durable medical equipment employers enactment end the following enrollee enrollment ensure establish evaluation federal fiscal funds GENERAL.-Section grant Health and Human health benefits plan health care Health Insurance Exchange health plan health workforce HIPAA hospital Human Services implement improve individual inserting items and services Law This provision Medicaid medical home Medicare Part D Medicare Prescription Drug ment mental health counselor nursing facility participate patient payment period PHSA sec PHSA section PHSA title physician pilot program premium prescription drug preventive services Proposed Law qualified health benefits quality measures rebate resident respect retary Security Act 42 Social Security Act specified standards striking submit subparagraph subsection Subtitle Task Force telehealth term tion United States Code