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State Laws

Search the Database to identify statutes and/or regulations in all 50 states that address common physician-private payer issues, such as overpayment and recoupment, retroactive denials, fee schedules, and appeals.

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Federal Laws

Find relevant federal laws like the Employee Retirement Income Security Act and Medicare Advantage regulations.

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AMA Policies

Access American Medical Association Policies

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Payment Issues

Fee Schedules	Fee Schedules-Med. Adv.	Liability-insurer shifting to physician
Liability-insurer shifting to physician-Med. Adv.	Most Favored Nation	Overpayments / Recoupments
Payment Edits	Payment Rules	Prohibited financial incentives
Prohibited financial incentives-Med. Adv.	Risk-Physicians Taking-Med. Adv.	Risk—Physicians Taking

Network Issues

Continuity of Care Post-Contract	Continuity of Care Post-Contract-Fed. Exchange Reg.	Continuity of Care Post-Contract-Med. Adv.
Credentialing-Deadlines	Credentialing-Due Process-Denial of Contract	Credentialing-Patient Demographics
Credentialing-Payment Issues	Directories	Directories-Fed. Exchange Reg.
Directories-Med. Adv.	Network Adequacy	Network Adequacy-Fed. Exchange Reg.
Network Adequacy-Med. Adv.	OON-Payment Issues	Participation in Products, Plans, or Networks
Profiling	Rental Networks

Contract Changes / Disputes

Amendments	Amendments-Med. Adv.	Anti-gag clause
Anti-gag clause-Med. Adv.	Anti-retaliation	Anti-retaliation-Med. Adv.
Restrictive Covenants	Termination	Termination-Due Process
Termination-Due Process-Med. Adv.	Termination-Med. Adv.

Coverage / Utilization Review

ERISA-Med. Nec. Appeals-Deadlines	ERISA-Med. Nec. Decisions-Deadlines	Med. Adv.-Med. Nec. Appeals-Deadlines
Med. Adv.-Med. Nec. Decisions-Deadlines	Medical Necessity-Definition	Preemption-ERISA
Preemption-Medicare Advantage	Retroactive Denial	State Medical Necessity Appeals-Deadlines
State Medical Necessity Decisions-Deadlines	Step Therapy Override	U.R. Criteria

An American Medical Association Managed Care Resource

State Laws

Federal Laws

AMA Policies

Payment Issues

Network Issues

Contract Changes / Disputes

Coverage / Utilization Review

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