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HOPPS CCI EDITS

 

Physicians CCI EDITS

 

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Moukawsher & Walsh, LLC
Pension and Employee Benefit Law

Benefitlawyers.com

 
 

Pomerantz Haudek Block Grossman & Gross LLP ("PHBG&G")

ERISA and Healthcare-Related Class Actions

SPD's for FEHB

FEHB Open Season and FSA Open Season

Patients' Bill of Rights and the Federal Employees Health Benefits Program

HIPPA Consumer Bill of Rights and Responsibilities

 

Federal Employees Health Benefit Plan

 

Federal Employees Health Benefits Program
FEHB Plan Brochures

 

Links to Plan Brochures for 2003

 

Links to Plan Brochures for 2004

 

Links to the FEHB Open Season for 2005 Brochures

 

FEHB 2005 Plan Information

 

Federal Employees Health Benefits Program

FEHB HANDBOOK

 

Kaiser state health facts

 

A State-by-State Breakdown of Health Insurance Mandates and Their Costs -- 2005 Edition (PDF) (Council for Affordable Health Insurance)

 

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TRICARE Handbook


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TRICARE Manuals

 

Health Benefits Summaries, SPD's, 
for  State
Employees

NJ STATE
HEALTH BENEFITS PROGRAM

SUMMARY PROGRAM DESCRIPTION (SPD)
for employees and retirees

January 2003 (pdf)

New Jersey State Health Benefits Program Home Page

 
SPD for MD State

2004 Health Benefits Booklet for Current Employees (pdf) View as HTML

 

Connecticut State Employees and Retirees Benefits Information

 

Ohio Benefits Package Summary for State Employees

DAS/HRD Benefits - Open Enrollment Manual - Table of Contents

Employee Benefits Handbook - HMO Benefit Summary

 

Virginia Healthcare for Employees

 

State of Colorado Benefits - Medical

-- Dental

 

ARKANSAS STATE EMPLOYEES GROUP BENEFIT SUMMARY PLAN DESCRIPTION [PDF]

DFA - Employee Benefits Division : Benefits Library - State

 

West Virginia Employee Benefits

 

Summary of EMPLOYEE BENEFITS for State of Hawaii Employees (pdf)

 

State of Hawaii - Department of Human Resources Development

 

NC Teachers and State Employees Comprehensive Major Medical Plan

 

Minnesota State Insurance benefits index - employees

State Employee Group Insurance Program (SEGIP) - agencies

 

 

[PDF] THE STATE OF NEW HAMPSHIRE SUMMARY OF BENEFITS (HMO)

[PDF] THE STATE OF NEW HAMPSHIRE SUMMARY OF BENEFITS (retiree)

 

Summary of Benefits Commonwealth of Massachusetts Employee/Retiree (pdf)

 

The State of Washington  State Employee Benefits

 

Texas  State Epmloyeee  Summary of Benefits

 

For Your Benefit for State Agency employees - Spring 2004 (PDF)

 

For Your Benefit for Higher Ed employees - Spring 2004 (PDF)

 

State of Michigan Employee Benefits Booklets

 

Kansas Active Employee Health Insurance Information

 

State of Idaho Handbooks and Manuals - Insurance Management - Department of Administration

 

Welcome to the Public Employees' Benefits Program of Nevada

 

Health Insurance Mandates in the States, 2004: a State-by-State Breakdown ... (PDF) (Council for Affordable Health Insurance)
 

Benefits - Office of Human Resources - Utah State University

Health Care Plan Forms for Regence Utah Members “The BlueCard Program”

 

Kaiser state health facts

 

 

BCBSM / BCN - Welcome to the Blue Cross Blue Shield of Michigan and Blue Care Network!

 

BCBSM - Members - Claims - Appealing Claims Decisions

 

Group Admin - Section 3 final

 

Group Admin - Section 7 final

 

Group Enrollment and Coverage Agreement
Terms and Conditions - Part A New Group Number

 

GROUP ENROLLMENT & COVERAGE AGREEMENT

 

ONE SUBSCRIBER

 

BlueCard Brochure

 

How Blue Care Network Delivers Care

 

BCBSM - Blues & You - Employment - Rating Analyst Supervisor

 

BCBSM - Agents - Agent Policies & Procedures

 

GROUP ENROLLMENT & COVERAGE AGREEMENT

 

ONE SUBSCRIBER

Blue Cross Blue Shield Association

The BlueCard® Program

 

BCBSA Plan Finder.

External Link to

Home

Listing of Blue Companies

 
How to process BCBS claims for out-of-area patients:

 

BlueCard Members (non-Medicare) Claims
   Medicare Supplemental Claims
   COB Claims and BlueCard

 

View a Glossary of BlueCard Terms

 

Group Administrators Home Page

 

Blue Solutions for Group Administrators

 

Group Administrator Manuals


First Priority Health Group Administrator Manual.


Traditional Group Administrator Manual
.

 

Group Administrator Forms

 

Tax Equity and Fiscal Responsibility Act (TEFRA)

 

Medicare Secondary Payor (MSP) Demand Letters

 

BCBSNC: Employers - Group Administrators Guide

 

Employers - Group Administrators Toolkit

 

BCBS SC Group Administrators Manuals

 

Horizon BCBSNJ - Group Administrators

 

For Employers and Group Administrators
(wa.regence.com)

 

Employee Groups : Group Administrator's Manual : Arkansas Blue Cross and Blue Shield

 

BCBSF - Employers
See our Group Administrator Guide to get the answers you need.

 

Manuals & Guides Independence Blue Cross

 

Benefits Administrator Guide.

 

Keystone Group Administrator Invoice Guide.

 

IBC Group Administrator Invoice Guide.

 

Kaiser Family Foundation

 

A CONSUMER GUIDE TO HANDLING DISPUTES WITH YOUR PRIVATE OR EMPLOYER HEALTH PLAN -

 

USNews.com: Health: In Brief: Public Health: Winning fights with your HMO (8/12/05)

 

A CONSUMER GUIDE TO HANDLING DISPUTES WITH YOUR PRIVATE OR EMPLOYER HEALTH PLAN -

 

Full printable report on PDF 

STATE-BY-STATE EXTERNAL REVIEW PROGRAMS

 Via- Kaiser Family Foundation

  AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
 
 

Kaiser statehealthfacts.org: 50 State Comparisons: Patients' Rights: External Review, 2002

 

Minnesota Statutes 2004 Table of chapters

 

[PDF] External Review (IRO) Laws by State (NCQA.org)

 

NCQA: National Committee for Quality Assurance

 

External Review Procedure for Health Insurance and Health Maintenance Organization (HMO) Complaints (Michigan.gov)

 

State External Review Laws [DOC]
(National Association of Health Underwriters)

 

2003_02 | Deal With Patient Complaints Before Arrival of Subpoenas

(managedcaremag.com)

HMOs should adopt a conflict-management, rather than dispute-resolution, approach to patient complaints.

 

 

Blue Cross Blue Shield Plan Administrative Expenses Approximate 11% of Premiums, According to Sherlock Company

 

 1199SEIU National Benefit & Pension Funds - SPDs

 

 City of Scottsdale Summary Plan Description [PDF]

 

 US AIRWAYS SPD

 

 BWXT Y-12

 

Employee Book of Benefits

 

Blue Cross Blue Shield of Michigan United of Omaha Major Medical for UM

 

BCBSMT PPO Manual

 

BCBSMT Utilization Review PDF

 

BCBSMT Claims Accuracy Initiative (CAI) Provider Manual PDF

 

Assistant Surgeon Codes Allowed PDF
 

BCBSMT Medical Policy

 

Urgent Care and Place of Service 20

 

Place of Service Codes for Professional Claims (CMS)
PDF format
Zipped Word format

SD: 58-17C STANDARDS FOR MANAGED CARE PLANS

 

58-17C-47      Prohibition against compensation influencing or based upon review decisions.

58-17C-64      Registration of utilization review organizations--Required information.

 

58-17C-67      Activities of nonregistered utilization review organizations prohibited.
 

58-17C-103      Promulgation of rules--Consistency with federal requirements.
 

36-4B-34.1 Peer review committee--Activities--Liability of members

 

36-4B-34.4 Peer review activity defined

 

36-4-42 Peer review committee defined

 

36-4-43 Peer review activities defined.

 

36-4B-34.2 Data of peer review committee--Disclosure--Discovery--Admissibility-- Testimony

 

36-4-26.1 Proceedings of peer review committees confidential and privileged--Availability to physician subject of proceedings.

 

36-5-19  Peer review committee--Immunity from liability--Conditions--Official immunity unaffected--

 

36-20B-53 Continuing professional education or peer review as condition for reissuance of certificate, license or permit.

 

 

Minnesota UR Statutes 2004 Table of chapters

CHAPTER 62M

UTILIZATION REVIEW OF HEALTH CARE

 

MN UR Act Summary for Chapter137

 

ND: 26.1-26.4

Health Care Service Utilization Review

SB 2184 – Minimum standards for utilization review (26.1-26.4-04). Provides for utilization

review standards consistent with federal law and with standards established by the United States

Department of Labor.

 

URAC States

Health Utilization Management

 
OIG: Special Advisory Bulletin: Practices of Business Consultants
 
'External Review' of Medical Claim Denials Is Now the Law of the Land Nearly Nationwide (Modern Healthcare via The Foundation for Taxpayer & Consumer Rights)
 

AFSCME 3357 HomePage

 

Plan Medical Coverage Booklet

(UAW GM Legal Services)

UAW Legal Services Plans

 
ChevronTexaco Health Benefits

 

Summary Plan Descriptions (SPDs)

SPD Health Benefits (229 pgs)

Complete SPD 720pgs

 
SAG-Producers Pension and Health Plans

Online Summary Plan Booklet

 
Northrop Grumman Benefits Online > Health > Summary Plan Descriptions

 

bullet Northrop Grumman Health Plan SPD
bullet Electronic Systems Health & Welfare Plan for Union Represented Employees
bullet Summary of Material Modifications for changes in oral contraceptive coverage effective April 1, 2002
bullet Northrop Grumman Ship Systems Employees' — Ingalls Operations Hourly Health and Disability Plan (PDF)
 
Northwestern University Health Care Plan Summary Plan Description
 
 
 
 
 
 
 

 

Create an Appeal Department

for Your Hospital or Practice

Please e-mail for further notice & details

630-736-2974

 

 

Why An Appeal Department???

 

  1. Now you have done your best for your coding and billing practice;

  2. Now you have done your best for your managed care contracting;

  3. Now you have done your best for your legislation for protections;

  4. Now you have done your best for cost &