417-F:1 Definitions. – In this chapter: I. " Emergency services " means health care services that are provided to an enrollee, insured, or subscriber in a licensed hospital emergency facility by a provider after the sudden onset of a medical condition that manifests itself by symptoms of sufficient severity that a prudent layperson with […]
417-F:2 Claims Processing. – An insurer retrospective review of a claim for reimbursement for emergency services shall include consideration of presenting symptoms, along with final diagnosis, and shall give due consideration to the definitions of emergency medical condition and emergency services in RSA 420-J:3. Source. 1997, 134:1, eff. Jan. 1, 1998. 2019, 16:1, eff. […]
417-F:3 Prior Authorization. – I. A participating provider or other authorized representative of the plan that gives prior authorization shall not rescind or modify the authorization after the health care provider has rendered the authorized emergency services care in good faith and the enrollee’s, insured’s, or subscriber’s coverage was effective on the date of […]
417-F:4 Reimbursement for Emergency Room Boarding. – Following the completion of an involuntary admission certificate for a patient meeting the criteria under RSA 135-C:27 and not rescinded under RSA 135-C:29-a, the insurer shall pay the acute care hospital a per diem day rate required to board and care for the patient, to be contracted […]
