Health Insurance Payment Systems State Law Survey

Get up to speed on the laws in all 50 U.S. states, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands regarding mandated coverage in healthcare insurance policies. Understand the requirements of the federal Patient Protection and Affordable Care Act (PPACA) and state provisions on mandated benefits reviews. Learn how states address the right to independent or external review of claims or coverage denials, restrictions on financial incentives to physicians, and requirements regarding premium rating types.

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Related Content

• Claims Processing in Health Insurance
  Review guidance on claims processing for commercial health insurance plans in both individual and group contexts. Gain insight into the fundamental elements of claims processing for medical and hospital claims and learn the importance of defining a claim, establishing a claims timeline, correctly submitting claims forms, and researching applicable laws, like the PPACA and Employee Retirement Income Security Act (ERISA), which govern claims processing.
• Claims Processing in Health Insurance Checklist
  Identify key claims processing issues that arise in commercial health insurance and better understand your client's claims processing obligations and how to identify laws, regulations, and administrative rules governing the process.
• Utilization Review in Health Insurance Checklist
  Understand utilization review (UR) activities of insurers and other parties who conduct UR on behalf of insurers. Advise insurance companies and other UR organizations about UR operations and compliance through recognition of applicable laws and regulations, state registration and licensing requirements, accreditation requirements, and insurer documents.

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