Effective 1/1/2018 31A-45-301. Written contracts — Limited liability of enrollee — Provider claim disputes — Leased networks. (1) A managed care organization may not contract with a health care provider for treatment of illness or injury unless the health care provider is licensed to perform that treatment. Every contract between a managed care organization and […]
Effective 1/1/2018 31A-45-302. Provider payment information — Notice of admissions. (1) (a) A managed care organization shall provide the managed care organization’s network providers access to current information necessary for the network provider to determine: (i) the effect of procedure codes on payment or compensation before a claim is submitted for a procedure; (ii) the […]
Effective 5/14/2019 31A-45-303. Network provider contract provisions. (1) Managed care organizations may provide for enrollees to receive services or reimbursement in accordance with this section. (2) (a) Subject to restrictions under this section, a managed care organization may enter into contracts with health care providers under which the health care providers agree to be a […]
Effective 1/1/2018 31A-45-304. Objective criteria for adding or terminating network providers — Termination of contracts — Review process. (1) (a) A managed care organization shall establish criteria for adding health care providers to a new or existing network provider panel. (b) Criteria under Subsection (1)(a) may include: (i) training, certification, and hospital privileges; (ii) number […]
Effective 5/14/2019 31A-45-305. Prohibition on certain age-based physician testing. A managed care organization or other third party may not require for purposes of reimbursement that a physician, as defined in Section 58-67-102, take a cognitive test when the physician reaches a specified age, unless the test reflects the standards described in Subsections 58-67-302(5)(b)(i) through (x). […]
