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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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-23-184.htm - 9K - Match Info - Similar pages
27-9A-3
Section 27-9A-3 Independent adjuster defined; exclusions. (a) For purposes of this chapter,
an "independent adjuster" is a person who, for compensation as an independent contractor
or as an employee of an independent contractor, undertakes on behalf of an insurer to ascertain
and determine the amount of any claim, loss, or damage payable under a contract of property,
casualty, or workers' compensation insurance or to effect settlement of such claim, loss,
or damage. This chapter shall not be construed to permit persons not licensed as attorneys
to engage in activities constituting the practice of law. (b) An independent adjuster does
not include any of the following: (1) Attorneys-at-law admitted to practice in this state
when acting in their professional capacity as an attorney. (2) A salaried employee of an insurer.
(3) A person employed solely to obtain facts surrounding a claim or to furnish technical assistance
to a licensed independent adjuster. (4) An individual who is employed...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-9A-3.htm - 4K - Match Info - Similar pages
36-26-14
Section 36-26-14 Deferred compensation plans for certain employees. (a) The personnel board
may adopt, establish, and maintain a deferred compensation plan or plans, except under Internal
Revenue Code Section 403 (b), for the employees of the State of Alabama or any city, town,
county, or public entity or corporation organized pursuant to the laws of this state. Notwithstanding
the foregoing, prior to the employees of a county or political subdivision of the county participating
in a plan, the employing county or political subdivision of the county shall approve participation
in the plan. The personnel board may include in any such plan any provision that does not
cause the plan to fail to qualify for its tax-favored treatment under the United States Internal
Revenue Code, including, but not limited to, participant loans, unforeseeable emergency or
hardship distributions, Roth deferrals, rollovers, transfers to purchase service credit, and
distributions to purchase a retired public...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/36-26-14.htm - 3K - Match Info - Similar pages
27-56-10
Section 27-56-10 Vision care providers - Contract requirements; rates; reimbursements; discounts.
(a) As used in this section, the following words shall have the following meanings: (1) CONTRACTUAL
DISCOUNT. A percentage reduction from a provider's usual and customary rate for covered services
and materials required under a participating provider agreement. (2) COVERED MATERIALS. Materials
for which reimbursement from the insurer or vision care plan is provided to a vision care
provider by an enrollee's plan contract, or for which a reimbursement would be available but
for the application of the enrollee's contractual limitations of deductibles, copayments,
or coinsurance. (3) COVERED SERVICES. Services for which reimbursement from the insurer or
vision care plan is provided to a vision care provider by an enrollee's plan contract, or
for which a reimbursement would be available but for the application of the enrollee's contractual
plan limitations of deductibles, copayments, or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-56-10.htm - 4K - Match Info - Similar pages
34-25A-3
Section 34-25A-3 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) ACCREDITED FACILITY. A facility where prosthetic, orthotic, prosthetic and orthotic,
or pedorthic care is provided to patients needing such care and has met the requirements of
the board for such designation. The board shall require that all accredited facilities meet
the requirements of a national certifying board, recognized by the state board in prosthetics,
orthotics, and pedorthics accredited by the National Commission for Certifying Agencies (NCCA)
in the discipline or disciplines for which the application is made and meet any other requirements
of the board. The requirements may include custom and non-custom items the board may determine
are necessary to perform quality care and are typical in the course of business. (2) ACCREDITED
PEDORTHIC FACILITY. A facility where pedorthic care may be provided that has met the requirements
of the board for such designation. An...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-25A-3.htm - 10K - Match Info - Similar pages
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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-21-260.htm - 11K - Match Info - Similar pages
22-50-17
Section 22-50-17 Operation of a facility for care or treatment of mental or emotional illness
or substance abuse, or services to persons with an intellectual disability. (a) No person,
partnership, corporation, or association of persons shall operate a facility or institution
for the care or treatment of any kind of mental or emotional illness or substance abuse or
for providing services to persons with an intellectual disability as defined in this chapter,
without being certified by the department or licensed by the State Board of Health; provided
that nothing in this section shall be construed so as to require a duly authorized physician,
psychiatrist, psychologist, social worker, licensed professional counselor operating under
the scope of his or her license, or Christian Science practitioner to obtain a license for
treatment of patients in his private office, unless he keeps two or more patients in his office
for continuous periods of 24 hours or more in one week, or that a church...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-50-17.htm - 1K - Match Info - Similar pages
27-15-52
Section 27-15-52 Definitions. The following terms shall have the following meanings: (1) COMMERCIALLY
REASONABLE EFFORT. The plans, processes, or procedures necessary to confirm the death of the
insured, contract owner or annuitant, or retained asset account holder against other available
records and information and, as applicable, to locate the beneficiary or beneficiaries or
other person entitled to payment pursuant to the terms of the policy or contract which have
been developed by each insurer and submitted to and approved by the department. (2) CONTRACT.
An annuity contract. The term contract shall not include an annuity used to fund an employment-based
retirement plan or program where the insurer is not committed by terms of the annuity contract
to pay death benefits to the beneficiaries of specific plan participants. (3) DEATH MASTER
FILE. The United States Social Security Administration's Death Master File or any other database
or service that is at least as comprehensive as...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-15-52.htm - 3K - Match Info - Similar pages
27-29-1
Section 27-29-1 Definitions. For purposes of this chapter, unless otherwise stated, the following
terms shall have the meanings respectively ascribed to them by this section: (1) AFFILIATE.
The term shall include an affiliate of, or person affiliated with, a specific person, and
shall mean a person that directly, or indirectly through one or more intermediaries, controls,
or is controlled by, or is under common control with, the person specified. (2) COMMISSIONER.
The Commissioner of Insurance, his or her deputies, or the Insurance Department as appropriate.
(3) CONTROL. The term shall include controlling, controlled by, or under common control with
and shall mean the possession, direct or indirect, of the power to direct or cause the direction
of the management and policies of a person, whether through the ownership of voting securities,
by contract other than a commercial contract for goods or nonmanagement services, or otherwise,
unless the power is the result of an official...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-29-1.htm - 5K - Match Info - Similar pages
30-3-191
Section 30-3-191 Definitions. When used in Sections 30-3-191 to 30-3-199, inclusive, the following
words shall have the following meanings: (1) ACCOUNT. A demand deposit account, checking or
negotiable withdrawal order account, savings account, time deposit account, or money-market
mutual fund account. (2) BUSINESS DAY. A day on which state offices are open for regular business.
(3) COMMERCIAL DRIVER LICENSE. A license issued to an individual that authorizes the individual
to drive a motor vehicle as part of conducting business. (4) CONFIDENTIAL INFORMATION. Information
provided by a service applicant or recipient or obtained from other sources about him or her
which may be released only as required by court order or state or federal law. (5) COURT.
A court of competent jurisdiction or administrative agency having the authority to issue and
enforce support orders. (6) DATA MATCH. An automated process of matching specified information
from the financial records of financial institutions...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/30-3-191.htm - 5K - Match Info - Similar pages
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