Live Free or Die Legal
This website is not an official source of law. This website does not provide legal advice. For official legal materials, verify against the relevant court, legislature, agency, or other official source. Legal information may be incomplete, outdated, or incorrectly processed. Consult a qualified attorney for advice about a specific legal matter.

This RSA section is an unofficial mirror, is not legal advice, and may be incomplete, outdated, or incorrectly processed.

RSA 420-J:8-h · Coverage and Payment for Services Provided at Participating Facilities by Nonparticipating Providers

Title
XXXVII: INSURANCE
Chapter
420-J · MANAGED CARE LAW
Status
current
Official source linked
Yes
Official source Copy section link

420-J:8-h Coverage and Payment for Services Provided at Participating Facilities by Nonparticipating Providers. –

Copy link
I.

Each health carrier that issues or renews any policy of health insurance shall cover services provided by nonparticipating providers at a participating facility in the same manner and without imposing any additional requirements as if the services were provided by a participating provider.

Copy link
II.

The patient's cost-sharing for items or services provided by a nonparticipating provider at a participating facility shall be calculated by the health carrier based on the lesser of the qualified payment amount, the billed amount, or the allowed amount for the item or service.

Copy link
III.

The health carrier shall pay the nonparticipating provider an amount based on the fair value considerations set out in RSA 420-J:8-e, IV, less any cost-sharing for the services provided.

Copy link
IV.

In the event of a dispute between a nonparticipating provider and a health carrier relative to the fair value of an item or service under this section, the commissioner shall make available, as provided in RSA 420-J:8-e, an independent dispute resolution process to determine the fair value payment amount. Source. 2024, 143:10, eff. Jan. 1, 2025. 2025, 191:23, eff. Sept. 13, 2025.

Copy link

Source note

Source. 2024, 143:10, eff. Jan. 1, 2025. 2025, 191:23, eff. Sept. 13, 2025.

Source history

  • 2024, 143:10, eff. Jan. 1, 2025
  • 2025, 191:23, eff. Sept. 13, 2025

Related materials

Bill relationships

  • 2026 HB1268 reference · effective 2027-01-01

    pharmacy or pharmacist to reverse and rebill the claim in question. (3) All claims adjudications, appeals, and utilization review processes shall comply with the requirements of RSA 420-J and rules promulgated thereunder. (b) For every drug for which the health carrier or pharmacy benefit manager establishes a maximum allowable cost to determine the drug product reimbursement, the health carrier or p

  • 2026 HB1323 amend · effective 2027-01-01

    shall consider the factors set forth in RSA 461-A:6. 10 New Section; Managed Care Law; Prior Authorization for Physical Therapy and Occupational Therapy; When Required. Amend RSA 420-J by inserting after section 6-e the following new section: 420-J:6-f Prior Authorization for Physical Therapy and Occupational Therapy; When Required. I. A health carrier shall not require prior authorization for

  • 2026 HB1323-FN amend · effective 2027-01-01

    shall consider the factors set forth in RSA 461-A:6. 10 New Section; Managed Care Law; Prior Authorization for Physical Therapy and Occupational Therapy; When Required. Amend RSA 420-J by inserting after section 6-e the following new section: 420-J:6-f Prior Authorization for Physical Therapy and Occupational Therapy; When Required. I. A health carrier shall not require prior authorization for

  • 2026 HB1463 reference

    nduct a detailed analysis and report, in consultation with practicing community physicians in every New Hampshire county and health system, to assess compliance with RSA 420-E and RSA 420-J and make recommendations for appropriate penalties for insurers and insurance carriers not in compliance with such chapters of law. The department shall report its findings to the speaker of the house of representative

  • 2026 HB1463-FN reference

    nduct a detailed analysis and report, in consultation with practicing community physicians in every New Hampshire county and health system, to assess compliance with RSA 420-E and RSA 420-J and make recommendations for appropriate penalties for insurers and insurance carriers not in compliance with such chapters of law. The department shall report its findings to the speaker of the house of representative

  • 2026 HB1638 amend

    ep therapy protocols when medically necessary. Be it Enacted by the Senate and House of Representatives in General Court convened: 1 New Subdivision; Step Therapy. Amend RSA 420-J by inserting after section 26 the following new subdivision: Step Therapy 420-J:27 Definitions. As used in this subdivision: I. "Advanced, metastatic cancer" means a cancer that has spread from the primary or orig

  • 2026 HB1638-FN amend

    ep therapy protocols when medically necessary. Be it Enacted by the Senate and House of Representatives in General Court convened: 1 New Subdivision; Step Therapy. Amend RSA 420-J by inserting after section 26 the following new subdivision: Step Therapy 420-J:27 Definitions. As used in this subdivision: I. "Advanced, metastatic cancer" means a cancer that has spread from the primary or orig

  • 2026 HB1744 amend

    Be it Enacted by the Senate and House of Representatives in General Court convened: 1 New Section; Managed Care Law; Mental Health Coverage Reporting and Oversight. Amend RSA 420-J by inserting after section 6-e the following new section: 420-J:6-e Mental Health Coverage Reporting and Oversight. I. Each health insurance carrier offering health benefit plans in this state shall submit an annual r

  • 2026 HB1744-FN amend

    Be it Enacted by the Senate and House of Representatives in General Court convened: 1 New Section; Managed Care Law; Mental Health Coverage Reporting and Oversight. Amend RSA 420-J by inserting after section 6-e the following new section: 420-J:6-e Mental Health Coverage Reporting and Oversight. I. Each health insurance carrier offering health benefit plans in this state shall submit an annual r

  • 2026 HB241 amend · effective 2027-01-01

    sed standards used in deciding which therapies should be available. 2 New Section; Managed Care Law; Development of a Comprehensive Program of Pain Management Services for the Management of Chronic Pain. Amend RSA 420-J by inserting after section 7-e the following new section: 420-J:7-f Development of a Comprehensive Program of Pain Management Services for the Management of Chronic Pain. I. Health carriers shall develop, in a

  • 2026 HB241-FN amend · effective 2027-01-01

    ich therapies should be available. 2 New Section; Managed Care Law; Development of a Comprehensive Program of Pain Management Services for the Management of Chronic Pain. Amend RSA 420-J by inserting after section 7-e the following new section: 420-J:7-f Development of a Comprehensive Program of Pain Management Services for the Management of Chronic Pain. I. Health carriers shall develop, in accorda

  • 2026 HB705 amend · effective 2026-03-16

    transparency. Be it Enacted by the Senate and House of Representatives in General Court convened: 5:1 New Subdivision; Managed Care Law; Transparency in Coverage. Amend RSA 420-J by inserting after section 26 the following new subdivision: Transparency in Coverage 420-J:27 Definitions. In this subdivision: I. “Billed charge” means the total charges for an item or service billed to a healt