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958 C.M.R. 3.00 – Health insurance consumer protection | Midpage
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Code of Massachusetts Regulations (CMR)
Title 958
Chapter 3.00
958 C.M.R. 3.00
Health insurance consumer protection
MGL c. 6D, § 16 MGL c. 176O
Massachusetts Health Policy Commission
3.001
Scope and Purpose
3.020
Definitions
3.100
Clinical Decisions
3.101
Carrier's Medical Necessity Guidelines
3.200
Internal Inquiry Process
3.300
Right to an Internal Grievance Process
3.301
Information on Internal Grievance Process
3.302
Form and Manner of Request
3.303
Carrier and Utilization Review Organization Records of Grievances
3.304
Carrier and Utilization Review Organization Acknowledgment of Internal Grievances
3.305
Time Limits for Resolution of Non-expedited Internal Grievances
3.306
Review of Internal Grievances
3.307
Form of Written Resolution of the Internal Grievance
3.308
Reconsideration of Carrier Decisions on Internal Grievances
3.309
Expedited Internal Review of Adverse Determinations
3.310
Right to Request a Conference
3.311
Failure of Carrier to Meet Time Limits
3.312
Coverage or Treatment Pending Resolution of Internal Grievance
3.313
Confidentiality
3.314
Internal Review Conference
3.401
Expedited External Review
3.402
Fees
3.403
Consent to Release of Medical Information
3.404
Form and Manner of Request for External Review
3.405
Screening of Requests for External Review
3.406
Requests Ineligible for External Review – Notification
3.407
Assignment of External Reviews
3.408
Notification of Assignment and Request for Information
3.409
Medical Records and Information
3.410
Review Panel
3.411
Conflict of Interest
3.412
Additional Medical or Other Information
3.413
Informal Meeting
3.414
Continuation of Services
3.415
Decisions and Notice
3.416
Confidentiality – External Review
3.417
External Review Conference
3.500
Disenrollment of Primary Care Provider
3.501
Disenrollment of Providers of Care to Pregnant Women
3.502
Disenrollment of Providers of Care to the Terminally Ill
3.503
Coverage for the Newly Insured
3.504
Carrier's Coverage Conditions
3.505
Standing Referrals
3.506
Specialty Care Not Requiring Prior Authorization
3.507
Coverage of Pediatric Specialty Care
3.508
Denial of Provider Application
3.509
Provider Termination Without Cause Provisions
3.600
Reporting Requirements
3.700
Required Oral Interpretation and Written Translation Services