Federal Laws

Internal claims and appeals and external review processes; Internal claims and appeals and external review processes (temporary)

Basis and scope (temporary); Applicability (temporary); Definitions (temporary); Preventing surprise medical bills for emergency services (temporary); Preventing surprise medical bills for non-emergency services performed by nonparticipating providers at certain participating facilities (temporary); Methodology for calculating qualifying payment amount; Methodology for calculating qualifying payment amount (temporary); Complaints process for surprise medical bills regarding group health plans (temporary); Independent dispute resolution process, Independent dispute resolution process (temporary); Preventing surprise medical bills for air ambulance services (temporary); Independent dispute resolution process for air ambulance services (temporary); Independent dispute resolution process for air ambulance services 

Preventing surprise medical bills; Ending surprise air ambulance bills

Claims Procedure

Basis and scope; Applicability; Definitions; Preventing surprise medical bills for emergency services; Preventing surprise medical bills for non-emergency services performed by nonparticipating providers at certain participating facilities; Methodology for calculating qualifying payment amount; Complaints process for surprise medical bills regarding group health plans and group health insurance coverage; Independent dispute resolution process; Preventing surprise medical bills for air ambulance services; Independent dispute resolution process for air ambulance services

Continuity of care

Protecting patients and improving the accuracy of provider directory information

Preventing surprise medical bills; Ending surprise air ambulance bills

How an MA organization must effectuate standard reconsidered determinations or decisions.