|
27-1-17.1
Section 27-1-17.1 Payment of providers through electronic funds transfer methods. (a) As used
in this section, the following words shall have the following meanings: (1) ACH ELECTRONIC
FUNDS TRANSFER. An electronic funds transfer through the Health Insurance Portability and
Accountability Act (HIPPA) standard Automated Clearing House network. (2) COVERED HEALTH CARE
PROVIDER. A physician as defined in Section 34-24-50.1; a dentist as defined in Section 34-9-1;
a chiropractor as defined in Section 34-24-120; an individual engaged in the practice of optometry
as defined in Section 34-22-1; other licensed health care professionals as defined in Title
34; a hospital as defined in Section 22-21-20; and a health care facility, or other provider
who or that is accredited, licensed, or certified and who or that is performing within the
scope of that accreditation, license, or certification. (3) HEALTH INSURANCE PLAN. Any hospital
and medical expense incurred policy, health maintenance...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-17.1.htm - 3K - 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
16-44B-1
Commission may deem appropriate. The executive director shall serve as secretary to the Interstate
Commission, but shall not be a Member of the Interstate Commission. The executive director
shall hire and supervise such other persons as may be authorized by the Interstate Commission.
D. The Interstate Commission's executive director and its employees shall be immune from suit
and liability, either personally or in their official capacity, for a claim for damage to
or loss of property or personal injury or other civil liability caused or arising
out of or relating to an actual or alleged act, error, or omission that occurred, or that
such person had a reasonable basis for believing occurred, within the scope of Interstate
Commission employment, duties, or responsibilities; provided, that such person shall not be
protected from suit or liability for damage, loss, injury, or liability caused by the
intentional or willful and wanton misconduct of such person. 1. The liability of...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/16-44B-1.htm - 46K - Match Info - Similar pages
27-56-2
Section 27-56-2 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) COVERED PERSON. Any individual, family, or family member on whose behalf third-party
payment or prepayment of health or medical expenses is provided under an insurance policy,
plan, or contract providing for third-party payment or prepayment of health care or medical
expenses. (2) EYE CARE PROVIDER. A licensed optometrist or a licensed ophthalmologist. (3)
INSURANCE POLICY, PLAN, OR CONTRACT PROVIDING FOR THIRD-PARTY PAYMENT OR PREPAYMENT OF HEALTH
OR MEDICAL EXPENSES. Includes an individual or group policy for accident or health insurance,
an individual or group hospital or health care service contract, an individual or group health
maintenance organization contract, an organized delivery system contract, or a preferred provider
organization contract, and any other similar policy, plan, or contract. This term shall not
include any employee welfare benefit plan, as defined...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-56-2.htm - 1K - Match Info - Similar pages
11-91A-2
Section 11-91A-2 Local Government Health Insurance Board; governance and administration of
program. (a) The Local Government Health Insurance Board shall govern and administer the Local
Government Health Insurance Program currently governed and administered by the State Employees'
Insurance Board (SEIB) pursuant to Chapter 29 of Title 36. The transfer of the governance
and administration to the board shall take effect at 12:01 a.m. on January 1, 2015, and thereafter
the board shall take all control and responsibility for the program under procedures and authority
set out in this chapter. (b) The program governed and administered by the board shall provide
a reasonable relationship between the health care benefits to be included and the expected
health care expenses to be incurred by affected employees, retirees, and their dependents.
The board may establish a fully insured or self-insured health care plan for employees and
retirees as defined in this chapter and may adopt rules for the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/11-91A-2.htm - 5K - Match Info - Similar pages
27-9A-3
system" means a preprogrammed computer system designed for the collection, data entry,
calculation, and system-generated final resolution of claims which meets all of the following:
1. It shall only be utilized by a licensed independent adjuster, licensed insurance producer,
or by individuals supervised by a licensed independent adjuster or insurance producer pursuant
to this subdivision. 2. It shall comply with all claims payment requirements of the insurance
code. d. For purposes of this subdivision, "portable consumer electronic device"
means a personal, self-contained, easily carried by an individual, battery-operated
electronic communication, viewing, listening, recording, gaming, computing, or global position
device, and other similar devices and their accessories. e. The licensed independent adjuster
or insurance producer who supervises the individuals shall file a report with the commissioner
indicating an intention to operate pursuant to this subdivision. (Act 2011-637, ยง1.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-9A-3.htm - 4K - Match Info - Similar pages
40-26B-70
Section 40-26B-70 Definitions. For purposes of this article, the following terms shall have
the following meanings: (1) ACCESS PAYMENT. A payment by the Medicaid program to an eligible
hospital for inpatient or outpatient hospital care, or both, provided to a Medicaid recipient.
(2) ALL PATIENT REFINED DIAGNOSIS-RELATED GROUP (APR-DRG). A statistical system of classifying
any non-Medicare inpatient stay into groups for the purposes of payment. (3) 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. (4) CERTIFIED PUBLIC EXPENDITURE (CPE). A certification
in writing of the cost of providing medical care to Medicaid beneficiaries by publicly owned
hospitals and hospitals owned by a state agency or a state university plus the amount of uncompensated
care provided by publicly owned hospitals and hospitals...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/40-26B-70.htm - 5K - Match Info - Similar pages
26-1A-404
regarding provision, withholding, or withdrawal of life-sustaining treatment and artificially
provided nutrition and hydration but only a. if specifically authorized to do so in the durable
power of attorney, b. if the substantive provisions of the durable power of attorney are in
substantial compliance and if the durable power of attorney is executed and accepted in substantially
the same form as set forth in the Alabama Natural Death Act, and c. in instances of terminal
illness or injury or permanent unconsciousness, if the authority is implemented in
the manner permitted under the Alabama Natural Death Act. All durable powers of attorney executed
prior to January 1, 2012, shall be effective to the extent specifically provided therein notwithstanding
the provisions of this subsection. The decisions made by the attorney in fact shall be implemented
in accordance with the same procedures set forth in the Alabama Natural Death Act for health
care proxies. (3) Any authority...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/26-1A-404.htm - 8K - Match Info - Similar pages
26-1-2
regarding provision, withholding, or withdrawal of life-sustaining treatment and artificially
provided nutrition and hydration but only a. if specifically authorized to do so in the durable
power of attorney, b. if the substantive provisions of the durable power of attorney are in
substantial compliance and if the durable power of attorney is executed and accepted in substantially
the same form as set forth in the Alabama Natural Death Act, and c. in instances of terminal
illness or injury or permanent unconsciousness, if the authority is implemented in
the manner permitted under the Alabama Natural Death Act. All durable powers of attorney executed
prior to May 8, 1997, shall be effective to the extent specifically provided therein notwithstanding
the provisions of this subsection. The decisions made by the attorney in fact shall be implemented
in accordance with the same procedures set forth in the Alabama Natural Death Act for health
care proxies. (3) Any authority granted...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/26-1-2.htm - 12K - 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
|