Section 4520.120  Post Stabilization Services

For purposes of determining compliance with Section 70 of the Act, timely determination shall mean a determination is made within 30 days after the health care plan receives a claim for post stabilization services if no additional information is needed to determine that services rendered were not contrary to the instructions of the health care plan or its delegated health care provider if the contact was made between those parties and the treating health care provider prior to the services being rendered.  In the event additional information is necessary to make such a determination, the health care plan shall request  the medical record documenting the time, phone number dialed,  and the result of the communication for request for authorization of post stabilization medical services as well as the post stabilization medical services rendered within 15 days after receipt of the post stabilization services claim and make a determination within 30 days after its receipt.