Know Your Legal Rights

Monday, April 09, 2018 11:05 AM
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Physician practices have rights under Colorado law that can be exercised to reduce health plan barriers to care. Those legal protections include but are not limited to: physician profiling, prior authorization and referrals, telehealth, anti-retaliation, narrow networks, timely payment, contracting, and appeals.

To help physicians and practice managers understand what those rights are, CMS staff has compiled countless physician protection statutes into helpful summaries and incorporated this information into a searchable members-only online database. Once you have logged into www.cms.org you can click on this link -- www.cms.org/kylr -- to browse through the topics addressed in the database.

What you need to know: Colorado statutes and regulations apply to fully insured health benefit plans.  They do not apply to self-funded health benefit plans or government plans.

Check the patient's ID card: if the initials “CO-DOI” are in the bottom left-hand corner of the card, the plan is under the jurisdiction of the Colorado Division of Insurance and these protections are in place for this patient and you.

You have to log into the CMS members-only website first (http://www.cms.org/member/login) before logging into the Know Your Legal Rights database (https://www.cms.org/kylr/).

A two-minute “how to” recording is available to illustrate how to navigate the database.

If you can’t find what you are looking for in Know Your Legal Rights, or if a link is broken, please contact marilyn_rissmiller@cms.org.

You have rights. Lots of them. We can show you.

 

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