Sec. 843.341. CLAIMS PROCESSING PROCEDURES. (a) A health maintenance organization shall provide a participating physician or provider with copies of all applicable utilization review policies and claim processing policies or procedures. (b) A health maintenance organization's claims payment processes shall: (1) use nationally recognized, generally accepted Current Procedural Terminology codes, notes, and guidelines, including all relevant modifiers; and (2) be consistent with nationally recognized, generally accepted bundling edits and logic.
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