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27-3A-3
Section 27-3A-3 Definitions. As used in this chapter, the following words and phrases shall
have the following meanings: (1) DEPARTMENT. The Alabama Department of Public Health. (2)
ENROLLEE. An individual who has contracted for or who participates in coverage under an insurance
policy, a health maintenance organization contract, a health service corporation contract,
an employee welfare benefit plan, a hospital or medical services plan, or any other benefit
program providing payment, reimbursement, or indemnification for health care costs for the
individual or the eligible dependents of the individual. (3) PROVIDER. A health care provider
duly licensed or certified by the State of Alabama. (4) UTILIZATION REVIEW. A system for prospective
and concurrent review of the necessity and appropriateness in the allocation of health care
resources and services given or proposed to be given to an individual within this state. The
term does not include elective requests for clarification of...
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27-58-1
Section 27-58-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare benefit
plan, policy, or contract for health care services issued, delivered, issued for delivery,
or renewed in this state by a health care insurer, health maintenance organization, accident
and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit
medical service corporation, health care service plan, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for insureds or beneficiaries in
this state. The term includes, but is not limited to, entities created pursuant to Article
6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to this chapter if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or on...
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27-59-1
Section 27-59-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare benefit
plan, policy, or contract for health care services issued, delivered, issued for delivery,
or renewed in this state by a health care insurer, health maintenance organization, accident
and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit
medical service corporation, health care service plan, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for insureds or beneficiaries in
this state. The term includes, but is not limited to, entities created pursuant to Article
6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to this chapter if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or on...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-59-1.htm - 1K - Match Info - Similar pages
22-11A-38
Section 22-11A-38 Notification of third parties of disease; rules; who may be notified; liability;
confidentiality; disclosure of information for certain criminal proceedings; penalty. (a)
The State Committee of Public Health is hereby authorized to establish the rules by which
exceptions may be made to the confidentiality provisions of this article and establish rules
for notification of third parties of such disease when exposure is indicated or a threat to
the health and welfare of others. All notifications authorized by this section shall be within
the rules established pursuant to this subsection. (b) Physicians and hospital administrators
or their designee may notify pre-hospital transport agencies and emergency medical personnel
of a patient's contagious condition. In case of a death in which there was a known contagious
disease, the physician or hospital administrator or their designee may notify the funeral
home director. (c) The attending physician or the State Health Officer...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-11A-38.htm - 5K - Match Info - Similar pages
26-15-3.3
Section 26-15-3.3 Mother of unborn child taking, with good faith belief, controlled substance
pursuant to a lawful prescription. (a) No one shall violate Section 26-15-3.2, and no one
shall be required to report under Chapter 14 of this title, the exposing of an unborn child
to any of the following: (1) A prescription medication if the responsible person was the mother
of the unborn child, and she was, or there is a good faith belief that she was, taking that
medication pursuant to a lawful prescription. (2) A non-prescription FDA approved medication
or substance if the responsible person was the mother of the unborn child, and she was, or
there is a good faith belief that she was, taking that medication or substance as directed
or recommended by a physician or a health care provider acting within the authorized scope
of his or her license. (b) No one shall be criminally liable under any Alabama law for the
assistance or conduct of exposing the unborn child to a medication or substance...
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26-16-112
Section 26-16-112 Definitions. For purposes of this arciclet, the following words shall have
the following meanings: (1) FORENSIC PATHOLOGIST. A pathologist trained or with experience
in forensic pathology, licensed to practice medicine and surgery or osteopathic medicine and
surgery in the State of Alabama and board certified by the American Board of Pathology, or
under the direct supervision of a physician with these qualifications. (2) INFANT DEATH. The
sudden death of an person less than one year of age whose death occurs outside the direct
care of a physician in a hospital or other health care setting. (3) SUDDEN UNEXPLAINED INFANT
DEATH (SUID). The sudden death of an infant less than one year of age whose death occurs outside
the direct care of a physician in a hospital or other health care setting and whose cause
of death is not reasonably ascertainable after a thorough investigation and examination by
the person signing the death certificate. (Act 2011-705, p. 2184, ยง3.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/26-16-112.htm - 1K - Match Info - Similar pages
27-1-16
Section 27-1-16 Standard health insurance claim form; electronic claims form; various claim
forms. (a)(1) The Commissioner of the Department of Insurance shall prescribe a standard health
insurance claim form to be used by all hospitals. The forms shall be prescribed in a format
which allows for the use of generally accepted diagnosis and treatment coding systems by providers
of health care and payors. The standard form shall be accepted and used by all insurers doing
business in the State of Alabama and by all state agencies which pay providers of health care
for hospital services. (2) The Commissioner of the Department of Insurance shall also prescribe
a format for all health insurance claims transmitted or submitted for payment by electronic
or electro-mechanical means. Such a format shall be used by all insurers doing business in
the State of Alabama and by all state agencies which pay providers of health care for hospital
services. (b) An advisory committee of five persons, two...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-16.htm - 3K - Match Info - Similar pages
27-3A-5
Section 27-3A-5 Standards for utilization review agents. (a) Except as provided in subsection
(b), all utilization review agents shall meet the following minimum standards: (1) Notification
of a determination by the utilization review agent shall be mailed or otherwise communicated
to the provider of record or the enrollee or other appropriate individual within two business
days of the receipt of the request for determination and the receipt of all information necessary
to complete the review. (2) Any determination by a utilization review agent as to the necessity
or appropriateness of an admission, service, or procedure shall be reviewed by a physician
or determined in accordance with standards or guidelines approved by a physician. (3) Any
notification of determination not to certify an admission, service, or procedure shall include
the principal reason for the determination and the procedures to initiate an appeal of the
determination. (4) Utilization review agents shall maintain...
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34-23-181
Section 34-23-181 Definitions. The following words shall have the following meanings as used
in this article: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare benefit
plan, policy, or contract for health care services issued, delivered, issued for delivery,
or renewed in this state by a health care insurer, health maintenance organization, accident
and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit
medical service corporation, health care service plan, or any other person, firm, corporation,
joint venture, or other similar business entity that pays for insureds or beneficiaries in
this state. The term includes, but is not limited to, entities created pursuant to Article
6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to this article if it receives, processes, adjudicates,
pays, or denies claims for health care services submitted by or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-23-181.htm - 3K - Match Info - Similar pages
22-21-11
Section 22-21-11 Mandatory reporting of any injury resulting from gunshot; liability. (a) Any
physician, nurse, or employee thereof or agent of the same and any employee or agent of a
hospital, mental health facility, clinic, or nursing home knowingly treating a person suffering
from a gunshot wound, or receiving a request for treatment, shall report the injury to a law
enforcement officer. A report to either the applicable county sheriff or applicable municipal
law enforcement officer shall satisfy any and all reporting requirements imposed by this section.
A report shall be made as soon as possible, but no later than the time of the victim's release
from that facility. No report is necessary if law enforcement is present. (b) Any person or
persons who, in good faith, makes a report or causes a report to be made to the appropriate
law enforcement authority pursuant to subsection (a) or participates in any judicial proceeding
or any other proceeding resulting from the report shall be...
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