§ 22:1260.31 Short title
§ 22:1260.32 Definitions
§ 22:1260.33 Notice requirements
§ 22:1260.34 Strict compliance required
§ 22:1260.35 Deadline for overpayment recoveries
§ 22:1260.36 Waiver prohibited
§ 22:1260.37 Injunction
§ 22:1260.38 Rules and regulations
§ 22:1260.41 For purposes of this Subpart, the following terms have the following meanings unless the context clearly indicates otherwise:
§ 22:1260.42 A. A health insurance issuer that requires the satisfaction of a utilization review as a condition of payment of a claim submitted by a healthcare provider shall maintain a documente
§ 22:1260.43 A health insurance issuer shall not impose any additional utilization review requirement with respect to any surgical procedure or otherwise invasive procedure, nor any item furnishe
§ 22:1260.44 A.(1) A health insurance issuer or utilization review entity shall maintain written procedures for making utilization review determinations and for notifying enrollees and providers
§ 22:1260.45 When conducting a utilization review, a health insurance issuer shall do all of the following:
§ 22:1260.46 A. When a healthcare provider makes a request for a utilization review, the health insurance issuer shall state if its response to the request is to certify or deny the request. If t
§ 22:1260.47 A. A health insurance issuer shall not deny any claim subsequently submitted for healthcare services specifically included in a prior authorization unless at least one of the followi
§ 22:1260.48 Nothing in this Subpart shall preclude a health insurance issuer from conducting investigations of possible fraud, waste, or abuse or taking appropriate actions based upon the result

Terms Used In Louisiana Revised Statutes > Title 22 > Chapter 4 > Part III > Subpart O - Physician and Provider Notification of Patients in Health Insurance Exchange Grace Period Act

  • 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.
  • Clerk of court: An officer appointed by the court to work with the chief judge in overseeing the court's administration, especially to assist in managing the flow of cases through the court and to maintain court records.
  • Contract: A legal written agreement that becomes binding when signed.
  • Enrollee: means a qualified individual or qualified employee enrolled in a qualified health plan. See Louisiana Revised Statutes 22:1260.32
  • Ex officio: Literally, by virtue of one's office.
  • exchange: means a governmental agency or nonprofit entity that meets the applicable standards of the Patient Protection and Affordable Care Act and makes qualified health plans available to qualified individuals and qualified employers. See Louisiana Revised Statutes 22:1260.32
  • Fraud: Intentional deception resulting in injury to another.
  • Grace period: is a period that applies to recipients of advance payments of the premium tax credit allowed for certain individuals to purchase health insurance coverage on the exchange. See Louisiana Revised Statutes 22:1260.32
  • Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. Source: Federal Reserve
  • Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • Lien: A claim against real or personal property in satisfaction of a debt.
  • Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • person: includes a body of persons, whether incorporated or not. See Louisiana Revised Statutes 1:10
  • Qualified health plan: means a health insurance plan that has in effect a certification that the qualified health plan meets applicable state or federal standards required for participation in a health insurance exchange. See Louisiana Revised Statutes 22:1260.32
  • Qualified health plan issuer: means a health insurance issuer that offers a qualified health plan in accordance with a certification from an exchange. See Louisiana Revised Statutes 22:1260.32