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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
13A-9-150
improperly charted, coded, or billed for any medical or health care service, common practices,
including but not limited to, repayment, even years later, may use as a defense to, or ground
for dismissal of, a prosecution under this section. (i) The introduction into evidence of
a paid state warrant to the order of the defendant is prima facie evidence that the defendant
did receive public assistance from the state. (j) The introduction into evidence of a transaction
history generated by a personal identification number (PIN) establishing a purchase
or withdrawal by electronic benefit transfer is prima facie evidence that the identified recipient
received public assistance from the state. (k)(1) If an original record is admissible in any
case or proceeding in a court in the state, a certified copy of the record in the custody
of any federal or state agency relating to an investigation of public assistance fraud under
this section shall be admissible when certified and affirmed by the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/13A-9-150.htm - 12K - Match Info - Similar pages
27-61-1
functions. 5. CORPORATE RECORDS OF THE COMMISSION The Commission shall maintain its corporate
books and records in accordance with the Bylaws. 6. QUALIFIED IMMUNITY, DEFENSE, AND INDEMNIFICATION
a. The Members, officers, executive director, employees, and representatives of the Commission,
the Executive Committee, and any other Committee of the Commission shall be immune from suit
and liability, either personally or in their official capacity, for any claim for damage to
or loss of property or personal injury or other civil liability caused by or
arising out of any actual or alleged act, error, or omission that occurred, or that the person
against whom the claim is made had a reasonable basis for believing occurred within the scope
of Commission employment, duties, or responsibilities; provided that nothing in this paragraph
shall be construed to protect any such person from suit and/or liability for any damage, loss,
injury, or liability caused by the intentional or willful or wanton...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-61-1.htm - 62K - Match Info - Similar pages
27-60-2
committees as its bylaws may provide for the carrying out of its functions. 4. Corporate records
of the commission. The commission shall maintain its corporate books and records in accordance
with the bylaws. 5. Qualified immunity, defense, and indemnification. a. The members, officers,
executive director, employees, and representatives of the commission shall be immune from
suit and liability, either personally or in their official capacity, for any claim for damage
to or loss of property or personal injury or other civil liability caused by
or arising out of any actual or alleged act, error, or omission that occurred, or that the
person against whom the claim is made had a reasonable basis for believing occurred within
the scope of commission employment, duties, or responsibilities. Nothing in this paragraph
shall be construed to protect any such person from suit or liability, or both, for any damage,
loss, injury, or liability caused by the intentional or willful and wanton...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-60-2.htm - 45K - Match Info - Similar pages
34-21-126
procedures related to specific employees or other matters related to the internal personnel
practices and procedures of the commission. c. Current, threatened, or reasonably anticipated
litigation. d. Negotiation of contracts for the purchase or sale of goods, services, or real
estate. e. Accusing any person of a crime or formally censuring any person. f. Disclosure
of trade secrets or commercial or financial information that is privileged or confidential.
g. Disclosure of information of a personal nature where disclosure would constitute
a clearly unwarranted invasion of personal privacy. h. Disclosure of investigatory
records compiled for law enforcement purposes. i. Disclosure of information related to any
reports prepared by or on behalf of the commission for the purpose of investigation of compliance
with this compact. j. Matters specifically exempted from disclosure by federal or state statute.
(6) If a meeting, or portion of a meeting, is closed pursuant to this subsection, the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-21-126.htm - 12K - Match Info - Similar pages
22-18-50
or procedures related to specific employees or other matters related to the Commission's internal
personnel practices and procedures; c. Current, threatened, or reasonably anticipated litigation;
d. Negotiation of contracts for the purchase or sale of goods, services, or real estate; e.
Accusing any person of a crime or formally censuring any person; f. Disclosure of trade secrets
or commercial or financial information that is privileged or confidential; g. Disclosure of
information of a personal nature where disclosure would constitute a clearly unwarranted
invasion of personal privacy; h. Disclosure of investigatory records compiled for law
enforcement purposes; i. Disclosure of information related to any investigatory reports prepared
by or on behalf of or for use of the Commission or other committee charged with responsibility
of investigation or determination of compliance issues pursuant to the Compact; or j. Matters
specifically exempted from disclosure by federal or member...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-18-50.htm - 41K - Match Info - Similar pages
27-1-17
Section 27-1-17 Limitation periods for payment of claims; overdue claims; retroactive denials,
adjustments, etc.; penalties. (a) Each insurer, health service corporation, and health benefit
plan that issues or renews any policy of accident or health insurance providing benefits for
medical or hospital expenses for its insured persons shall pay for services rendered by Alabama
health care providers within 45 calendar days upon receipt of a clean written claim or 30
calendar days upon receipt of a clean electronic claim. If the insurer, health service corporation,
or health benefit plan is denying or pending the claim, the insurer, health service corporation,
or health benefit plan shall, within 45 calendar days for a written claim and 30 calendar
days for an electronic claim, notify the health care provider or certificate holder of the
reason for denying or pending the claim and what, if any, additional information is required
to process the claim. Any undisputed portion of the claim...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-17.htm - 17K - Match Info - Similar pages
27-14-11.1
27-14-11.1 Contents of policies - Denial or reduction of benefits due to Medicaid eligibility
void. (a) For purposes of this section, "private insurer" is defined as any of the
following: (1) Any commercial insurance company offering health or casualty insurance to individuals
or groups, including both experience-rated contracts and indemnity contracts. (2) Any profit
or nonprofit prepaid plan offering either medical services or full or partial payment for
the diagnosis or treatment of an injury, disease, or disability. (3) Any organization
administering health or casualty insurance plans for professional associations, unions, fraternal
groups, employer-employee benefit plans, and any similar organization offering these payments
or services, including self-insured and self-funded plans. (4) Any health insurer, including
group health plans, as defined in Section 607(1) of the Employee Retirement Income Security
Act of 1974, self-insured plans, service benefit plans, managed care...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-14-11.1.htm - 3K - Match Info - Similar pages
16-33B-4
Loan Law. No obligation of ACHE for purposes of the loan program or for losses on student loans
resulting from death, default, bankruptcy, or total or permanent disability of the student
borrowers shall ever (i) create an obligation or a debt of the State of Alabama or any agency
or political subdivision thereof other than ACHE or a charge against the credit or taxing
powers of the state or any agency or political subdivision thereof other than ACHE, or (ii)
create or give rise to any personal liability of any of the commissioners or officers
of ACHE, but shall be payable solely from the ACHE "Student Loan Program Fund".
(13) To enter into contracts, agreements or covenants with, to accept aid, loans and grants
from, to cooperate with, to make loan servicing arrangements and other management arrangements
with, and to do any and all things not specifically prohibited by this chapter or other applicable
laws of the state that may be necessary in order for ACHE to avail itself of...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/16-33B-4.htm - 10K - Match Info - Similar pages
22-21-265
Section 22-21-265 Certificates of need - Required for new institutional health service. (a)
On or after July 30, 1979, no person to which this article applies shall acquire, construct,
or operate a new institutional health service, as defined in this article, or furnish or offer,
or purport to furnish a new institutional health service, as defined in this article, or make
an arrangement or commitment for financing the offering of a new institutional health service,
unless the person shall first obtain from the SHPDA a certificate of need therefor. Notwithstanding
any provisions of this article to the contrary, those facilities and distinct units operated
by the Department of Mental Health, and those facilities and distinct units operating under
contract or subcontract with the Department of Mental Health where the contract constitutes
the primary source of income to the facility, shall not be required to obtain a certificate
of need under this article. (b) Notwithstanding all other...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/22-21-265.htm - 15K - Match Info - Similar pages
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