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27-19A-4
Section 27-19A-4 Required provisions. Any health insurance policy or employee benefit plan
which is delivered, renewed, issued for delivery, or otherwise contracted for in this state
shall, to the extent that it provides benefits for dental care expenses: (1) Disclose, if
applicable, that the benefit offered is limited to the least costly treatment; (2) Define
and explain the standard upon which the payment of benefits or reimbursement for the cost
of dental care services is based, such as "usual and customary," "reasonable
and customary," "usual, customary, and reasonable," fees or words of similar
import or specify in dollars and cents the amount of the payment or reimbursement for dental
care services to be provided. Said payment or reimbursement for a noncontracting provider
dentist shall be the same as the payment or reimbursement for a contracting provider dentist;
provided, however, that the health insurance policy or the employee benefit plan shall not
be required to make...
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34-23-112
Section 34-23-112 Required contractual provisions. Any agreement or contract entered into in
this state between the program administrator of a third party program and a pharmacy shall
include a statement of the method and amount of reimbursement to the pharmacy for services
rendered to persons enrolled in the program, the frequency of payment by the program administrator
to the pharmacy for such services rendered, and a method for the adjudication of complaints
or the settlement of disputes between the parties. (Acts 1981, No. 81-337, p. 477, §3.)...
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22-21-375
Section 22-21-375 Issuance of license; revocation; procedures for review and mediation of complaints.
(a) The Department of Insurance shall issue a license to each applicant upon payment of the
prescribed fees and upon being satisfied that: (1) The applicant has been organized in a bona
fide manner for the purpose of establishing, maintaining, and operating a dental service plan.
(2) Each contract executed, or proposed to be executed, by the applicant and a dentist obligates,
or will when executed obligate, such dentist to render the service or accept payment for the
service to which each subscriber may be entitled under the terms of the contract issued to
the subscriber. (3) Each contract issued, or proposed to be issued, to subscribers is in a
form approved by the department and that the rates charged, or proposed to be charged, for
each form of such contract and benefits to be provided pursuant thereto are fair and reasonable
and are actuarially sound. (4) No contributions to the...
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22-6-220
Section 22-6-220 Definitions. For the purposes of this article, the following words shall have
the following meanings: (1) CAPITATION PAYMENT. A payment the state Medicaid Agency makes
periodically to the integrated care network on behalf of each recipient enrolled under a contract
for the provision of medical services pursuant to this article. (2) COLLABORATOR. A private
health carrier, third party purchaser, provider, health care center, health care facility,
state and local governmental entity, or other public payers, corporations, individuals, and
consumers who are expecting to collectively cooperate, negotiate, or contract with another
collaborator, or integrated care network in the health care system. (3) INTEGRATED CARE NETWORK.
One or more statewide organizations of health care providers, with offices in each regional
care organization region, that contracts with the Medicaid Agency to provide Medicaid benefits
to certain Medicaid beneficiaries as defined in subdivision (4) and...
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22-6-150
Section 22-6-150 Definitions. For the purposes of this article, the following words shall have
the following meanings: (1) ALTERNATE CARE PROVIDER. A contractor, other than a regional care
organization, that agrees to provide a comprehensive package of Medicaid benefits to Medicaid
beneficiaries in a defined region of the state pursuant to a risk contract. (2) CAPITATION
PAYMENT. A payment the state Medicaid Agency makes periodically to a contractor on behalf
of each recipient enrolled under a contract for the provision of medical services. (3) CARE
DELIVERY SYSTEM. The manner in which the benefits and services set forth in the state Medicaid
plan are provided to Medicaid beneficiaries. (4) COLLABORATOR. A private health carrier, third
party purchaser, provider, health care center, health care facility, state and local governmental
entity, or other public payers, corporations, individuals, and consumers who are expecting
to collectively cooperate, negotiate, or contract with another...
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26-10B-8
Section 26-10B-8 Department to provide coverage and benefits not provided by residence state;
procedure for reimbursement. The State Department of Human Resources shall provide coverage
and benefits for a child who is in another state and who is covered by an adoption assistance
agreement made by the State Department of Human Resources for coverage or benefits, if any,
not provided by the residence state. To this end, the adoptive parents acting for the child
must obtain prior approval from the State Department of Human Resources and may submit evidence
of payment for services or benefit amounts not payable in the residence state and shall be
reimbursed therefor. However, there shall be no reimbursement for services or benefit amounts
covered under any insurance or other third party medical contract or arrangement held by the
child or the adoptive parents. The State Department of Human Resources shall make regulations
implementing this section. Among other things, such regulations...
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34-27A-58
Section 34-27A-58 Confirmation of competency; when payments due. (a) Before placing an assignment
with an appraiser, an appraisal management company shall require that the appraiser confirm
in writing or via electronic means that the appraiser receiving the assignment is a competent
appraiser for the performance of the appraisal being assigned. (b) An appraisal management
company operating in this state, except in cases of a mutually agreed upon payment date, breach
of contract, or performance of services that violates Uniform Standards of Professional Appraisal
Practice or any published standards of best practices, shall make payment to an appraiser
for the completion of an appraisal or valuation assignment within 45 days after the date the
appraisal management company, or an assignee, receives a completed appraisal or valuation
study. (Act 2011-701, p. 2161, §3.)...
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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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22-21-361
Section 22-21-361 Definitions. The following terms shall have the meanings respectively ascribed
by this section unless the context clearly indicates otherwise: (1) COMMISSIONER. The commissioner
of insurance of this state. (2) DENTAL SERVICE PLAN or PLAN. Any plan or other arrangement
whereby dental services are provided in whole or in part through a dental service corporation
by dentists participating in the plan to provide dental services to those members of the public
who become subscribers to the plan under a contract with such corporation. The terms "dental
service plan" or "plan" do not include an insurer authorized by the insurance
department to transact insurance in this state or to a nonprofit health insurance plan organized
pursuant to Section 10-4-100, or to any policy of insurance or contract which includes dental
benefits issued by such insurer or nonprofit health insurance plan. (3) DEPARTMENT. The Department
of Insurance. (4) LICENSE. The certificate of authority issued...
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22-6-153
Section 22-6-153 Contract to provide medical care to Medicaid beneficiaries; enrollment; grievance
procedures; duties of Medicaid Agency. (a) Subject to approval of the federal Centers for
Medicare and Medicaid Services, the Medicaid Agency shall enter into a contract in each Medicaid
region for at least one fully certified regional care organization to provide, pursuant to
a risk contract under which the Medicaid Agency makes a capitated payment, medical care to
Medicaid beneficiaries. However, the Medicaid Agency may enter into a contract pursuant to
this section only if, in the judgment of the Medicaid Agency, care of Medicaid beneficiaries
would be better, more efficient, and less costly than under the then existing care delivery
system. The Medicaid Agency may contract with more than one regional care organization in
a Medicaid region. Pursuant to the contract, the Medicaid Agency shall set capitation payments
for the regional care organization. (b) The Medicaid Agency shall...
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