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Seminar Schedules in IL NC, PA, VA, OH, SD

 
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Moukawsher & Walsh, LLC
Pension and Employee Benefit Law

Benefitlawyers.com

 
 
 

SPD's for FEHB

Federal Employees Health Benefit Plan

Federal Employees Health Benefits Program
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FEHB Plan Brochures

Links to Plan Brochures for 2003

Links to Plan Brochures for 2004

Federal Employees Health Benefits Program

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Click The State Name for Time, Location & Agenda of Each Seminar

Seminar Schedules in IL NC, PA, VA, OH, SD, Teleconference

 

Health Benefit Plan External Review (FAQs) and
"External Review" Search Results from and links to
North Carolina Department of Insurance Home Page
 

 

North Carolina Chiropractic Association

Presents

Stop Managed Care Abusive Claim Delays & Denials!
Getting Paid by Compliance with New Federal Claim (ERISA) Rules

The Most Powerful & only Seminar in the U.S.
on Health Care
ERISA Claim Denials & Appeals

A $1.0 Trillion Nuclear Solution to Our Nation's Health-care Crisis &
$44 Trillion Future U.S. Budget Deficit

 

Jan. 18. 2003

 

 

North Carolina Chiropractic Association

Attention DCs and CAs:

Need Training on HIPAA Compliance?

Health Claim Denials and Appeals?

If you said yes, sign up today for the next installment of our

"Building Your Practice" Series!

* Saturday, January 18, 2003          Holiday Inn Raleigh-Durham Airport

* 9:00 am - 6:00 pm          Research Triangle Park NC

Sponsored by the North Carolina Chiropractic Association

Please note:  The HIPAA portion ot this program is approved for three hours of license renewal credit In North Carolina.

 

HIPAA Privacy Program with Dr. Kate Rufolo, DC

Our opening presentation is a detailed review of the new regulations required under the Health Insurance Portability and Accountability Act issued by Health and Human Services. Topics to be covered are vital to your practice and include the following:

Who Is Covered By HIPAA
Permitted Uses & Disclosures of Health Information
Forms & Authorizations
 HIPAA Privacy Policies and Procedures
Resolving Conflicts Between Consents and Authorizations
Internal Security for Patient Information and
The Patient's Right to Access Their Health Records

Your registration will also Include a copy of the NCCA HIPAA Compliance Manual Don't be left out!!

 

 Health Claim Denials and Appeals Seminar
with Dr. Jin Zhou & Dr. Spyros Bakis

Following the HIPAA program will be a five-hour intensive and comprehensive explanation of Federal ERISA claims regulations, which have been a confusion for over twenty-seven years, This advanced program, designed for both the practitioner and experienced insurance filers, will be of enormous benefit to every chiropractic office. Reasons you should attend:

*This is the FIRST and ONLY COMPLETE ERISA PROGRAM in the COUNTRY
*ERISA REGULATES 80% of your Health Insurance CLAIMS DENIALS*
*ERISA compliance is mandatory by FEDERAL LAW, 65 FR 7146*
*Your rights to appeal CLAIM DENIALS & DELAYS can be TAKEN AWAY from you!*
*ERISA offers the BEST PROTECTION for physicians and health-care providers in Managed Care denials*

THIS PROGRAM WILL ALSO INCLUDE A REVIEW OF THE NEW NORTH CAROLINA "EXTERNAL REVIEW LAW" IN EFFECT JULY 1, 2002. SPACE IS LIMITED. REGISTER TODAY!!

For more information on why an understanding of ERISA regulations will be invaluable to you and your practice, please visit www.ERISAclaim.com.

 

9:00 a.m.- 12:O0 p.m.

"HIPAA Privacy Program"
         with Dr. Kate Rufolo, DC

12:00 p.m.-1:00 p.m.

Lunch on your own

1:00 pm - 6:00 pm:

"HeaItbcire Claim Denials and Appeals Seminar"
        with Dr. Jin Zhou and Dr. Spyros Bakis

Location:

Program Fees

Holiday Inn Raleigh-Durham Airport
4810 Old Page Road
Research Triangle Park, NC 27709
(919) 941-6000


Be sure to request the NCCA group rate of $79. Reservations made after July 19th are subject to availability and may not receive the group rate, so call today!!

 

 

Postmarked by 01/07/03

After 01/07/03

NCCA DC Member

$100

$125

Nonmember DC

$135

$160

NCCA CA Member

$70

$95

Nonmember CA

$80

$105

Student

$80

$105

"Building Your Practice - Jan. 18th"    Registration Form    "Building Your Practice - Jan. 18th"

 

Attendee(s) (Please indicate DC or CA) _________________________________________________

_________________________________________________________________________________

Chiropractic Office

____________________________________________________________________

Address

____________________________________________________________________

City, Stat; Zip

____________________________________________________________________

Phone

____________________________________

 Fax__________________________

Amount Enclosed $_____   _______Check ______Visa ______Master card      _____Discover

Card Number ________________________________Exp. Date__________________

Signature

______________________________________________________

Mail form with payment to: N.C. Chiropractic Association, 333.Fayttteville Street Mall, Suite 1500, Ra1eigh, NC 27601

or fax it to (919) 832-0613. Questions? Call the NCCA at (919) 832-0611

 

Why ERISA Seminars for Health-care Providers?

 

North Carolina Protections

RUSH PRUDENTIAL HMO, INC. v. MORAN [00-1021]
U.S. Supreme Court, Decided June 20, 2002

North Carolina Patients' Rights:

North Carolina Offers New Way To Appeal Health Insurance Claim Denials (insure.com)
Excerpt: "Beginning July 1, 2002, many North Carolina consumers will have a new option for handling disputes when their HMO claims are denied. That's when the state's 'external review law' goes into effect."

Link to
North Carolina Department of Insurance Home Page

Office of Managed Care Patient Assistance Opens in North Carolina (KaiserNetwork.org)
Excerpt: "North Carolina Gov. Mike Easley (D) on Nov. 25 opened a new Office of Managed Care Patient Assistance in the state Department of Justice as part of a patients' rights law enacted last October, the AP/Raleigh News & Observer reports ..."

June 27, 2002 -- Health Insurance Consumers Have New External Review Option for Handling Disputes
 

NORTH CAROLINA DEPARTMENT OF INSURANCE PROMPT PAY GUIDANCE [PDF]
 
North Carolina Department of Insurance: Guidance On North Carolina Law As Affected By U.S. DOL Claims Rules (March 21, 2002) (PDF)
 

Health Benefit Plan External Review

Frequently Asked Questions

Managed Care Patients' Bill of Rights. (Public)

External Review 2000
50 State Comparisons:

North
Carolina

Yes

Applies to any health insurer.
Type of Grievance: Any decision, policy or action of the insurer that affects the covered person.
Filing Time Limit: None.
Filing Fee: $0.
State Authority: The North Carolina Department of Insurance.

North Carolina  State Recognition of URAC Accreditation
North Carolina

-Health UM
-Department of Insurance Publication

Requirement for compliance with the Health Utilization Management Standards of the American Accreditation healthcare Commission (URAC), URAC Version 3 (pdf)

 

North Carolina General Statutes
Chapter 58 - Insurance.

58-50-61. Utilization review. [RTF]

58-50-62. Insurer grievance procedures. [RTF]

North Carolina Administrative Code

 

Title 10 - Health and Human Services

 

Title 11 - Insurance

Search Results
Documents 1 to 10 of 88 matching the query "Utilization review".

1.

Chapter 12 Rules

 

Abstract: History Note: Authority G.S. 58-2-40(1) 58-50-60; Eff. February 1, 1991; Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4. 11 NCAC 12 .0904 REQUIREMENTS FOR UTILIZATION REVIEW History Note: Authority G.S. 58-2-40(1) 58-50-60; Eff. March 1, 1991; Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4. 11 NCAC 12 .0905 UTILIZATION REVIEW PLAN 11 NCAC 12 .0906 MINIMUM STANDARDS FOR UTILIZATION REVIEW ENTITIES 11 NCAC 12 .0907 ACCESSIBILITY 11 NCAC 12 .0908 STANDARD DATA ELEMENTS 1

 

http://ncrules.state.nc.us/ncadministrativ_/title11insuranc_/chapter12lifean_/chapter12rules/50897x.htm
size 1,991 bytes - 6/22/02 10:42:12 PM GMT

2.

Chapter 12 Rules

 

Abstract: History Note: Authority G.S. 58-2-40(1) 58-50-60; Eff. February 1, 1991; Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4. 11 NCAC 12 .0904 REQUIREMENTS FOR UTILIZATION REVIEW History Note: Authority G.S. 58-2-40(1) 58-50-60; Eff. March 1, 1991; Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s. 4.4. 11 NCAC 12 .0905 UTILIZATION REVIEW PLAN 11 NCAC 12 .0906 MINIMUM STANDARDS FOR UTILIZATION REVIEW ENTITIES 11 NCAC 12 .0907 ACCESSIBILITY 11 NCAC 12 .0908 STANDARD DATA ELEMENTS 1

 

http://ncrules.state.nc.us/ncadmi~1/title1~2/ch2067~1/chapte~1/50897x.htm
size 1,991 bytes - 6/22/02 10:42:12 PM GMT

3.

SubChapter E Rules

 

Abstract: SUBCHAPTER 10E - WORKERS' COMPENSATION RULES FOR UTILIZATION REVIEW SECTION .0100 - RULES 04 NCAC 10E .0101 UTILIZATION REVIEW PLAN (a) All insurance companies and self-insured administrators providing benefits under the North Carolina Workers' Compensation Act shall, within 90 days of the effective date of these Rules, adopt, file with the Chairman of the North Carolina Industrial Commission at 430 N. Salisbury Street, Raleigh, NC 27611 and implement a Utilization Review Plan for containing med

 

http://ncrules.state.nc.us/ncadmi~1/title0~4/cha056~1/su49d3~1/3146x.htm
size 1,893 bytes - 6/22/02 8:00:46 PM GMT

4.

SubChapter E Rules

 

Abstract: SUBCHAPTER 10E - WORKERS' COMPENSATION RULES FOR UTILIZATION REVIEW SECTION .0100 - RULES 04 NCAC 10E .0101 UTILIZATION REVIEW PLAN (a) All insurance companies and self-insured administrators providing benefits under the North Carolina Workers' Compensation Act shall, within 90 days of the effective date of these Rules, adopt, file with the Chairman of the North Carolina Industrial Commission at 430 N. Salisbury Street, Raleigh, NC 27611 and implement a Utilization Review Plan for containing med

 

http://ncrules.state.nc.us/ncadministrativ_/title04commerce_/chapter10indust_/subchaptererule/3146x.htm
size 1,893 bytes - 6/22/02 8:00:46 PM GMT

5.

Chapter 20 Rules

 

Abstract: CHAPTER 20 - MANAGED CARE HEALTH BENEFIT PLANS SECTION .0100 - MANAGED CARE DEFINITIONS 11 NCAC 20 .0101 SCOPE AND DEFINITIONS (a) Scope. (1) Sections .0200, .0300, and .0400 of this Chapter apply to HMOs, licensed insurers offering PPO benefit plans, and any other entity that falls under the definition of "network plan carrier" (2) Sections .0500 and .0600 of this Chapter apply only to HMOs. (3) Nothing in this Chapter applies to service corporations offering benefit plans under G.S. 58-65-25 o

 

http://ncrules.state.nc.us/ncadministrativ_/title11insuranc_/chapter20manage_/chapter20rules/3146x.htm
size 4,676 bytes - 6/22/02 10:47:40 PM GMT

6.

Title 10 - Health and Human Services Rules

 

Abstract: LEGISLATIVE SESSION 2002 OAH Draft of Approved Rule 6/22/02 10 NCAC 03R .6320 MAGNETIC RESONANCE IMAGING SCANNERS NEED DETERMINATION BASED ON FIXED MRI SCANNER UTILIZATION (REVIEW CATEGORY H) It is determined that there is a need for eight additional fixed Magnetic Resonance Imaging (MRI) Scanners based on fixed MRI Scanner utilization in the following Magnetic Resonance Imaging Scanners Service Areas. It is determined that there is no need for an additional fixed MRI Scanner in any other servic

 

http://ncrules.state.nc.us/2002rulespendin_/title10healthan_/title10healthan/16108x.htm
size 3,274 bytes - 6/22/02 6:35:19 PM GMT

7.

Chapter 20 Rules

 

Abstract: CHAPTER 20 - MANAGED CARE HEALTH BENEFIT PLANS SECTION .0100 - MANAGED CARE DEFINITIONS 11 NCAC 20 .0101 SCOPE AND DEFINITIONS (a) Scope. (1) Sections .0200, .0300, and .0400 of this Chapter apply to HMOs, licensed insurers offering PPO benefit plans, and any other entity that falls under the definition of "network plan carrier" (2) Sections .0500 and .0600 of this Chapter apply only to HMOs. (3) Nothing in this Chapter applies to service corporations offering benefit plans under G.S. 58-65-25 o

 

http://ncrules.state.nc.us/ncadmi~1/title1~2/ch7c81~1/chapte~1/3146x.htm
size 4,676 bytes - 6/22/02 10:47:40 PM GMT

8.

SubChapter R Rules

 

Abstract: 10 NCAC 03R .6316 SOLID ORGAN TRANSPLANTATION SERVICES NEED DETERMINATION (REVIEW CATEGORY H) It is determined that there is no need for new solid organ transplantation services anywhere in the State. History Note: Authority G.S. 131E-176(25) 131E-177(1) 131E-183(b) Temporary Adoption Eff. January 1, 2001. 10 NCAC 03R .6317 GAMMA KNIFE UNIT NEED DETERMINATION (REVIEW CATEGORY H) It is determined that there is no need for additional gamma knife units anywhere in the State. History Note: Authority

 

http://ncrules.state.nc.us/ncadmi~1/title1~1/chapte~3/su4d04~1/102028x.htm
size 3,225 bytes - 6/22/02 9:00:38 PM GMT

9.

SubChapter D Rules

 

Abstract: for the patient's primary compensable condition, if a physician of that specialty meets the MCO's reasonable credentialing criteria for that specialty and is willing to contract to provide their services on a non-discriminatory basis. History Note: Authority G.S. 97-2(19) 97-2(20) 97-25; 97-25.2; Eff. January 1, 1996. 04 NCAC 10D .0109 QUALITY ASSURANCE AND UTILIZATION REVIEW An MCO subject to these Rules shall comply with the requirements of the N.C. Department of Insurance for quality assuranc

 

http://ncrules.state.nc.us/ncadministrativ_/title04commerce_/chapter10indust_/subchapterdrule/4822x.htm
size 1,474 bytes - 6/22/02 8:00:37 PM GMT

10.

SubChapter D Rules

 

Abstract: for the patient's primary compensable condition, if a physician of that specialty meets the MCO's reasonable credentialing criteria for that specialty and is willing to contract to provide their services on a non-discrimiatory basis. History Note: Authority G.S. 97-2(19) 97-2(20) 97-25; 97-25.2; Eff. January 1, 1996. 04 NCAC 10D .0109 QUALITY ASSURANCE AND UTILIZATION REVIEW An MCO subject to these Rules shall comply with the requirements of the N.C. Department of Insurance for quality assuranc

 

http://ncrules.state.nc.us/ncadmi~1/title0~4/cha056~1/subcha~4/4822x.htm
size 1,474 bytes - 6/22/02 8:00:37 PM GMT

       

Seminar Schedules in IL NC, PA, VA, OH, SD, Teleconference

Associations for Physicians, Hospitals, Health-care Providers
We are willing to work with any associations with your co-sponsorship and significant discount for tuitions and reference books. You may e-mail or telephone for more details.

$10,600 ERISA Claim

Recent Federal Court Ruling in a Case with $10,600 medical claim, insurance Co. refused to pay, provider made numerous demand for payment in almost one year, but no appeals filed, the court dismissed the lawsuit because provider failed to exhaust administrative remedy, as required under ERISA, by filing ERISAclaim appeals.  This situation is so popular in health-care community.

 


 

$37,350 ERISA Claim

Health-care provider alleged medical claims submitted to Aetna for reimbursement, Aetna asserted no receipt of medical claims, no written denials.  Health-care provider failed to present proof of claim submission, claim denial and ERISA claim appeals. This case was dismissed. ERISA health-care claims are handled in federal court, state law is generally not applicable.

 


 

 


 

 


 

Peer Review


 

 

 

 

Statutes (United States Code) 
ERISA - Title 29, Chapter 18. 
        Selected links:
Sec. 1002.
Definitions
Sec. 1003.
Coverage
Sec. 1022.
Summary plan description
Sec. 1104.
Fiduciary duties
Sec. 1140.
Interference with protected rights
Sec. 1141.
Coercive interference
part 7
group health plan requirements


 

 

Code of Federal Regulations

Codified in Title 29 of the Code of Federal Regulations:
Regulations
        Selected links:
2520.102-3 Contents of summary plan description.
2560.503-1 
Claims procedure.

 

 

 

 

 

Seminar Schedules in ILNC, PA, VA, OH,  Teleconference

 
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