Utah Code 31A-22-637. Health care provider payment information — Notice of admissions
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(1) For purposes of this section, “insurer” is as defined in Section 31A-22-636.
Terms Used In Utah Code 31A-22-637
- Contract: A legal written agreement that becomes binding when signed.
- Health care: means any of the following intended for use in the diagnosis, treatment, mitigation, or prevention of a human ailment or impairment:(83)(a) a professional service;(83)(b) a personal service;(83)(c) a facility;(83)(d) equipment;(83)(e) a device;(83)(f) supplies; or(83)(g) medicine. See Utah Code 31A-1-301
- Health care provider: means the same as that term is defined in Section
78B-3-403 . See Utah Code 31A-1-301- Rate: means :
(163)(a)(i) the cost of a given unit of insurance; or(163)(a)(ii) for property or casualty insurance, that cost of insurance per exposure unit either expressed as:(163)(a)(ii)(A) a single number; or(163)(a)(ii)(B) a pure premium rate, adjusted before the application of individual risk variations based on loss or expense considerations to account for the treatment of:(163)(a)(ii)(B)(I) expenses;(163)(a)(ii)(B)(II) profit; and(163)(a)(ii)(B)(III) individual insurer variation in loss experience. See Utah Code 31A-1-301(2)(2)(a) An insurer shall provide its health care providers who are under contract with the insurer access to current information necessary for the health care provider to determine:(2)(a)(i) the effect of procedure codes on payment or compensation before a claim is submitted for a procedure;(2)(a)(ii) the plans and carrier networks that the health care provider is subject to as part of the contract with the carrier; and(2)(a)(iii) in accordance with Subsection 31A-26-301.6(10)(f), the specific rate and terms under which the provider will be paid for health care services.(2)(b) The information required by Subsection (2)(a) may be provided through a website, and if requested by the health care provider, notice of the updated website shall be provided by the carrier.(3)(3)(a) An insurer may not require a health care provider by contract, reimbursement procedure, or otherwise to notify the insurer of a hospital in-patient emergency admission within a period of time that is less than one business day of the hospital in-patient admission, if compliance with the notification requirement would result in notification by the health care provider on a weekend or federal holiday.(3)(b) Subsection (3)(a) does not prohibit the applicability or administration of other contract provisions between an insurer and a health care provider that require pre-authorization for scheduled in-patient admissions. - Health care provider: means the same as that term is defined in Section