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Details of Tracking Number  2013-00944

CCR details

Tracking Number 2013-00944
Type of Filing Permanent Rule
Department 700 Department of Regulatory Agencies
Agency 702 Division of Insurance
CCR Number 3 CCR 702-4 Series 4-2

Proposed rule

Rule ProposedRuleAttach2013-00944.DOC
Statutory Authority 10-1-109, 10-3-1110, 10-16-109, and 10-16-113(2) and (10)
Purpose/Objective of Rule The purpose of this regulation is to set forth guidelines for carrier compliance with the provisions of 10-3-1104(1)(h), 10-16-409(1)(a), and 10-16-113, C.R.S., in situations involving utilization review and certain denials of benefits for treatment, as well as rescission, cancellation, or denial of coverage based on an eligibility determination, as described herein. Among other things, 10-3-1104(1)(h), C.R.S., requires carriers to adopt and implement reasonable standards for the prompt investigation of claims arising from health coverage plans; promptly provide a reasonable explanation of the basis in the health coverage plan in relation to the facts or applicable law for denial of a claim or for the offer of a compromise settlement; and refrain from denying a claim without conducting a reasonable investigation based upon all available information. This regulation is designed to provide minimum standards for handling appeals and grievances involving utilization review determinations, certain denials of benefits for treatments excluded by health coverage plans, and as otherwise required by 10-16-113, C.R.S.
Comments Keenan Lorenz
Submitted in response to issues raised by COLS/OLLS? No
Hearing Date 10/01/2013
Hearing Time 01:00 PM
Hearing Location 1560 Broadway, Ste 850, Denver CO 80202
Contact name Christine Gonzales-Ferrer
Contact title Rulemaking Coordinator
Contact telephone 303-894-2157
Contact email christine.gonzales-ferrer@state.co.us

Adopted rule

Adopted Rules AdoptedRules02013-00944.DOC
Redline Redline2013-00944.DOC
Adopted Date 10/08/2013
Attorney General Opinion 10/24/2013
Effective Date 12/01/2013
Inserted into CCR 11/21/2013