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35-11-371
Section 35-11-371 Perfection of lien. (a) For the purposes of this section, the
following terms shall have the following meanings: (1) HEALTH CARE PAYOR. A health care insurer,
health maintenance organization, or health care service plan organized under Article 6, Chapter
20, Title 10A, authorized to provide health care coverage in the state. (2) SATISFY THE CLAIM.
Receipt by the hospital of either of the following: a. Full payment for services as billed.
b. If the hospital has a contract with the injured person's health care payor, payment together
with all credits, discounts, and contractual adjustments that the patient's bill would be
entitled under the contract, including recoupments, between the hospital and the patient's
health care payor which extinguish the patient's obligation for the services rendered. (b)
Unless specifically contrary to any contractual agreement between the hospital and the injured
person's health care payor or unless contrary to any statute or governmental...
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35-11-372
Section 35-11-372 Release or satisfaction. (a) During the period of time allowed by
Section 35-11-371 for perfecting the lien, including that period of time during which
the hospital is awaiting payment or denial by the patient's health care payor, and also after
the lien provided for by this division has been perfected by any lienholder entitled thereto,
no release or satisfaction of any action, claim, counterclaim, demand, judgment, settlement,
or settlement agreement, or of any of them, shall be valid or effectual as against the lien
unless the lienholder shall join therein or execute a release of the lien. (b) Any acceptance
of a release or satisfaction of any action, claim, counterclaim, demand, or judgment and any
settlement of any of the foregoing in the absence of a release or satisfaction of the lien
referred to in this division shall prima facie constitute an impairment of the lien, and the
lienholder shall be entitled to a civil action for damages on account of the...
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34-23-184
Section 34-23-184 Audit procedures; report. (a) The entity conducting an audit shall
follow these procedures: (1) The pharmacy contract shall identify and describe in detail the
audit procedures. (2) The entity conducting the on-site audit shall give the pharmacy written
notice at least two weeks before conducting the initial on-site audit for each audit cycle.
If the pharmacy benefit manager does not include their auditing guidelines within their provider
manual, then the notice must include a documented checklist of all items being audited and
the manual, including the name, date, and edition or volume, applicable to the audit and auditing
guidelines. For on-site audits a pharmacy benefit manager shall also provide a list of material
that is copied or removed during the course of an audit to the pharmacy. The pharmacy benefit
manager may document this material on either a checklist or on an audit acknowledgement form.
The pharmacy shall produce any items during the course of the...
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25-5-1
Section 25-5-1 Definitions. Throughout this chapter, the following words and phrases
as used therein shall be considered to have the following meanings, respectively, unless the
context shall clearly indicate a different meaning in the connection used: (1) COMPENSATION.
The money benefits to be paid on account of injury or death, as provided in Articles 3 and
4. The recovery which an employee may receive by action at law under Article 2 of this chapter
is termed "recovery of civil damages," as provided for in Sections 25-5-31 and 25-5-34.
"Compensation" does not include medical and surgical treatment and attention, medicine,
medical and surgical supplies, and crutches and apparatus furnished an employee on account
of an injury. (2) CHILD or CHILDREN. The terms include posthumous children and all other children
entitled by law to inherit as children of the deceased; stepchildren who were members of the
family of the deceased, at the time of the accident, and were dependent upon him or...
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22-21-260
Section 22-21-260 Definitions. As used in this article, the following words and terms,
and the plurals thereof, shall have the meanings ascribed to them in this section,
unless otherwise required by their respective context: (1) ACQUISITION. Obtaining the legal
equitable title to a freehold or leasehold estate or otherwise obtaining the substantial benefit
of such titles or estates, whether by purchase, lease, loan or suffrage, gift, devise, legacy,
settlement of a trust or means whatever, and shall include any act of acquisition. The term
"acquisition" shall not mean or include any conveyance, or creation of any lien
or security interest by mortgage, deed of trust, security agreement, or similar financing
instrument, nor shall it mean or include any transfer of title or rights as a result of the
foreclosure, or conveyance or transfer in lieu of the foreclosure, of any such mortgage, deed
of trust, security agreement, or similar financing instrument, nor shall it mean or include
any...
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13A-9-150
Section 13A-9-150 Public assistance fraud; penalties. (a) For the purposes of this section,
public assistance means money or property provided directly or indirectly to eligible persons
through programs of the federal government, the state, or any political subdivision thereof,
including any program administered by a public housing authority. (b) It shall be unlawful
for an individual or business entity to knowingly do any of the following: (1) Fail, by false
statement, misrepresentation, impersonation, or other fraudulent means, to disclose a material
fact used in making a determination as to the qualification of the person to receive public
assistance. (2) Fail to disclose a change in circumstances in order to obtain or continue
to receive any public assistance to which he or she is not entitled or in an amount larger
than that to which he or she is entitled. (3) Aid and abet another person in the commission
of the prohibitions enumerated in subdivisions (1) and (2). (4) Use,...
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25-5-293
Section 25-5-293 Duties of secretary; continuing education, accounting; recovery of
expenses; advisory committees; legislative intent regarding reimbursements. (a) The Secretary
of the Department of Labor may prescribe rules and regulations for the purpose of conducting
continuing education seminars for all personnel associated with workers' compensation claims
and collect registration fees in order to cover the related expenditures. The secretary may
adopt rules and regulations setting continuing education standards for workers' compensation
claims personnel employed by insurance companies and self-insured employers and groups. (b)
The secretary shall file annually with the Governor and the presiding officer of each house
of the Legislature a complete and detailed written report accounting for all funds received
and disbursed during the preceding fiscal year. The annual report shall be in the form and
reported in the time provided by law. (c) The secretary shall establish reasonable...
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25-4-10
Section 25-4-10 Employment. (a) Subject to other provisions of this chapter, "employment"
means: (1) Any service performed prior to January 1, 1978, which was employment as defined
in this section prior to such date and, subject to the other provisions of this section,
services performed for remuneration after December 31, 1977, including service in interstate
commerce, by: a. Any officer of a corporation; or b. Any individual who, under the usual common
law rules applicable in determining the employer-employee relationship, has the status of
an employee; or c. Any individual other than an individual who is an employee under paragraphs
a. or b. of this subdivision (1) who performs services for remuneration for any person: 1.
As an agent-driver or commission-driver engaged in distributing meat products, bakery products,
beverages (other than milk) or laundry or dry cleaning services for a principal; 2. As a traveling
or city salesman engaged upon a full-time basis in the solicitation on...
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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...
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27-49-3
Section 27-49-3 Definitions. As used in this chapter, the following terms shall have
the following meanings: (1) HEALTH BENEFIT PLAN. Any individual or group plan, policy, or
contract for health care services issued, delivered, issued for delivery, 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, purchases, or furnishes health care services
to patients, insureds, or beneficiaries in this state. The term includes, but is not limited
to, entities created pursuant to Article 6 of Chapter 4 of Title 10. For the purposes of this
chapter, a health benefit plan located or domiciled outside of the State of Alabama is deemed
to be subject to the provisions of this chapter if it receives, processes,...
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