|§ 27-3A-1||Short title|
|§ 27-3A-4||Duties of utilization review agents|
|§ 27-3A-5||Standards for utilization review agents|
|§ 27-3A-6||Violations of chapter by utilization review agent|
Terms Used In Alabama Code > Title 27 > Chapter 3A
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- department: The Alabama Department of Public Health. See Alabama Code 45-40-161
- enrollee: An individual who has contracted for or who participates in coverage under an insurance policy, a health maintenance organization contract, a health service corporation contract, an employee welfare benefit plan, a hospital or medical services plan, or any other benefit program providing payment, reimbursement, or indemnification for health care costs for the individual or the eligible dependents of the individual. See Alabama Code 45-40-161
- Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
- Fraud: Intentional deception resulting in injury to another.
- Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. Source: FDIC
- Misdemeanor: Usually a petty offense, a less serious crime than a felony, punishable by less than a year of confinement.
- provider: A health care provider duly licensed or certified by the State of Alabama. See Alabama Code 45-40-161
- UTILIZATION REVIEW: A system for prospective and concurrent review of the necessity and appropriateness in the allocation of health care resources and services given or proposed to be given to an individual within this state. See Alabama Code 45-40-161
- UTILIZATION REVIEW AGENT: Any person or entity, including the State of Alabama, performing a utilization review, except the following:
a. See Alabama Code 45-40-161