Follow HealthChoice authorization for release of medical records (260:45-3-4)

HealthChoice authorization for release of medical records is listed as a rule section (260:45-3-4) under Records and Information; providers must follow the HealthChoice authorization requirements when requesting or disclosing member medical records as governed by rule 260:45-3-4.

• Rule reference: 260:45-3-4 — HealthChoice authorization for release of medical records (listed in Subchapter 3 headings and TOC).

260:45-3-4 — HealthChoice authorization for release of medical records

Rule 260:45-3-4 (HealthChoice authorization for release of medical records) is explicitly listed in the document table of contents and headings; providers must comply with the authorization procedures set out under that rule when releasing member records.

• 260:45-3-4 appears repeatedly in the Subchapter 3 headings and TOC as the governing authorization rule.

Authorization for release of medical records (heading — 260:45-3-4)

Authorization for release of medical records appears as a Subchapter 3 heading (260:45-3-4); providers should locate and reference that rule when preparing or responding to record release requests.

• Heading shown in Subchapter 3: 260:45-3-4. HealthChoice authorization for release of medical records.

Reference: HealthChoice authorization for release of medical records

The document references HealthChoice authorization for release of medical records as a rule heading within the records and information subchapter; providers must reference that rule in documentation and authorization workflows.

• Listed alongside related sections: right to receive and release necessary information (260:45-3-5) and call monitoring (260:45-3-6).

TOC reference — HealthChoice authorization for release of medical records (260:45-3-4)

HealthChoice authorization for release of medical records (rule 260:45-3-4) is referenced multiple times across the table of contents; providers must ensure any release of records cites and follows the requirements of 260:45-3-4.

• 260:45-3-4 is shown in the TOC together with related records/information rules (260:45-3-1 through 260:45-3-7).

Grievance hearings conducted by three-member Grievance Panel (260:45-5-4)

Grievance hearings are conducted by a three-member Grievance Panel as listed under Subchapter 5 (260:45-5-4); providers participating in hearings should be prepared for a three-member panel process.

• Rule reference in TOC: 260:45-5-4 — Grievance hearings conducted by the three [3] member Grievance Panel.

Request, Notice, and Prehearing actions (260:45-5-1 to 260:45-5-3)

The Grievance Panel Procedures table of contents lists Request for hearing (260:45-5-1), Notice of hearing (260:45-5-2), and Prehearing conference (260:45-5-3); providers must use these procedures when initiating or responding to grievance hearings.

• Request for hearing — 260:45-5-1 (listed in Subchapter 5 TOC).
• Notice of hearing — 260:45-5-2 (listed in Subchapter 5 TOC).
• Prehearing conference — 260:45-5-3 (listed in Subchapter 5 TOC).

Subchapter 5 headings — Grievance Panel Procedures

Subchapter 5 headings include Request for hearing, Notice of hearing, Prehearing conference, Grievance hearings (three-member panel), Continuance/disposition, Attorney representation, and Certificate of mailing; providers must follow these headings when preparing grievance submissions and notices.

• 260:45-5-1. Request for hearing
• 260:45-5-2. Notice of hearing
• 260:45-5-3. Prehearing conference
• 260:45-5-4. Grievance hearings conducted by the three [3] member Grievance Panel
• 260:45-5-5. Continuance; disposition; Attorney representation
• Certificate of mailing (procedural heading listed in Subchapter 5 table entries).

Grievance Panel Procedures — table entries (260:45-5-1 to 260:45-5-5)

Grievance Panel Procedures table entries list the core procedural steps providers must expect and comply with when involved in a grievance: request for hearing, notice of hearing, prehearing conference, three-member grievance panel hearings, continuance/disposition, and attorney representation.

• Expect procedures under 260:45-5-1 through 260:45-5-5 as listed in the table entries.
• Grievance hearings will be conducted by a three-member panel (260:45-5-4).

Subchapter 1 contents — administrative TOC (refer to cited sections for details)

Subchapter 1 table of contents lists many administrative topics (Purpose; Underpaid premiums; Refunds; Continuation rights; Dependents; Eligibility criteria including disabled dependent over age 26) but does not contain the substantive authorization or release-of-records rules in the excerpt; providers should refer to the specific cited sections for operative requirements.

• Subchapter 1 TOC entries include Purpose; Underpaid premiums; Refunds; Rights of eligible former employees to continue; Coverage for eligible non-vested employee; Effective dates; Participating entities; Dependents; Eligibility criteria for disabled dependent over age 26.

Administrative procedures overview — TOC (260:50-3-21 to 260:50-3-28)

The administrative procedures overview (TOC) lists procedural topics such as termination, continuation, mid-year election changes, corrections, double coverage prohibition, basic disclosure for Medicare beneficiaries, procedures and COBRA administration; providers should consult the specific sections (e.g., 260:50-3-22 through 260:50-3-28) for actionable rules.

• Referenced procedural sections include 260:50-3-21 through 260:50-3-28 (continuation, mid-year changes, corrections, double coverage, basic disclosure, termination, procedures and COBRA administration).

Referenced policy headings — authorization-relevant sections (260:50-5-1 to 260:50-5-13)

The document index and referenced policy headings list selection of health plans, schedule of benefits, plan limits, covered charges, limitations and exclusions, and payment procedures; providers must reference those specific sections (e.g., 260:50-5-1 to 260:50-5-13) for authorization-relevant benefit rules.

• Selection of health plans — 260:50-5-1
• Schedule of benefits and benefit administration — 260:50-5-2
• Plan limits — 260:50-5-10
• Covered charges — 260:50-5-11
• HealthChoice plan limitations and exclusions — 260:50-5-12
• Payment of benefits — 260:50-5-13

Referenced policy sections (index) — consult listed sections for requirements

The document provides an index of referenced policy sections (selection of health plans; continuation for survivors; mid‑year benefit election changes; corrections; COBRA administration) which providers must consult for the precise administrative and authorization procedures applicable to member benefits.

• Index references include 260:50-3-21 through 260:50-3-28 and 260:50-5-1 through 260:50-5-13.

Schedule of benefits and benefit administration — follow EGID-adopted procedures (260:50-5-2)

Schedule of benefits and benefit administration procedures or guidelines are listed as adopted by EGID (260:50-5-2); providers must follow the schedule and benefit administration rules adopted by EGID when seeking authorizations or determining coverage.

• 260:50-5-2 — Schedule of benefits and benefit administration procedures or guidelines as adopted by EGID (listed in TOC).

Table of contents — authorization-relevant sections (selection, schedule, limits, covered charges)

The table of contents lists numerous authorization-relevant sections — selection of health plans, schedule of benefits, plan limits, covered charges, limitations/exclusions, and payment of benefits — and providers must reference those numbered sections for authorization, billing, and coverage rules.

• Authorization-relevant TOC entries: 260:50-5-1 through 260:50-5-13 and 260:50-3-21 through 260:50-3-28.