reglab/housing_qa huggingface dataset:
Ohio Rev Code § 3901.371 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3901 | Superintendent of Insurance|Section 3901.371 | Purpose of Sections 3901.371 to 3901.378.

Effective: January 1, 2015|Latest Legislation:  Senate Bill 140 - 130th General Assembly|The purpose of sections 3901.371 to 3901.378 of the Revised Code is to provide the requirements for maintaining a risk management framework and completing an own risk and solvency assessment, and to provide guidance and instructions for filing an own risk and solvency assessment summary report with the superintendent of insurance. The requirements of these sections shall apply to all insurers domiciled in this state unless exempt pursuant to section 3901.376 of the Revised Code. The general assembly finds and declares that the own risk and solvency assessment summary report will contain confidential and sensitive information related to an insurer or insurance group's identification of risks material and relevant to the insurer or insurance group filing the report. This information will include proprietary and trade secret information that has the potential for harm and competitive disadvantage to the insurer or insurance group if the information is made public. It is the intent of the general assembly that the own risk and solvency assessment summary report shall be a confidential document filed with the superintendent, that the own risk and solvency assessment summary report will be shared only as stated in sections 3901.371 to 3901.378 of the Revised Code to assist the superintendent of insurance in the performance of the superintendent's duties, and that in no event shall the own risk and solvency assessment summary report be subject to public disclosure.
Ohio Rev Code § 3901.372 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3901 | Superintendent of Insurance|Section 3901.372 | Definitions.

Effective: January 1, 2015|Latest Legislation:  Senate Bill 140 - 130th General Assembly|For the purposes of sections 3901.371 to 3907.378 of the Revised Code: (A) "Insurance group" means those insurers and affiliates included within an insurance holding company system as defined in section 3901.32 of the Revised Code.(B) "Insurer" has the same meaning as set forth in section 3901.32 of the Revised Code.(C) "Own risk and solvency assessment" means a confidential internal assessment, appropriate to the nature, scale, and complexity of an insurer or insurance group, conducted by that insurer or insurance group of the material and relevant risks associated with the insurer or insurance group's current business plan, and the sufficiency of capital resources to support those risks.(D) "Own risk and solvency assessment guidance manual" means the current version of the own risk and solvency assessment guidance manual developed and adopted by the national association of insurance commissioners and as amended from time to time. A change in the own risk and solvency assessment guidance manual shall be effective on the first day of January following the calendar year in which the changes have been adopted by the national association of insurance commissioners.(E) "Own risk and solvency assessment summary report" means a confidential high-level summary of an insurer or insurance group's own risk and solvency assessment.
Ohio Rev Code § 3901.373 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3901 | Superintendent of Insurance|Section 3901.373 | Risk Management Framework.

Effective: January 1, 2015|Latest Legislation:  Senate Bill 140 - 130th General Assembly|An insurer shall maintain a risk management framework to assist the insurer with identifying, assessing, monitoring, managing, and reporting on its material and relevant risks. This requirement may be satisfied if the insurance group of which the insurer is a member maintains a risk management framework applicable to the operations of the insurer.
Ohio Rev Code § 3901.374 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3901 | Superintendent of Insurance|Section 3901.374 | Own Risk and Solvency Assessment.

Effective: January 1, 2015|Latest Legislation:  Senate Bill 140 - 130th General Assembly|Unless exempted by section 3901.376 of the Revised Code, an insurer, or the insurance group of which the insurer is a member, shall regularly conduct an own risk and solvency assessment consistent with a process comparable to the own risk and solvency assessment guidance manual. The own risk and solvency assessment shall be conducted not less than annually, but also at any time when there are significant changes to the risk profile of the insurer or the insurance group of which the insurer is a member.
Ohio Rev Code § 3901.375 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3901 | Superintendent of Insurance|Section 3901.375 | Summary Report.

Effective: January 1, 2015|Latest Legislation:  Senate Bill 140 - 130th General Assembly|(A)(1) Upon the request of the superintendent of insurance, and not more than once annually, an insurer shall submit to the superintendent an own risk and solvency assessment summary report, or any combination of reports that together contain the information described in the own risk and solvency assessment guidance manual, applicable to the insurer or the insurance group of which it is a member. (2) Notwithstanding any request from the superintendent, if the insurer is a member of an insurance group, the insurer shall submit the report required by division (A)(1) of this section if the superintendent is the lead state commissioner of the insurance group as determined by the procedures within the financial analysis handbook adopted by the national association of insurance commissioners.(B) The report shall include a signature of the insurer or insurance group's chief risk officer, or other executive having responsibility for the oversight of the insurer's enterprise risk management process, attesting to the best of the officer's or executive's belief and knowledge that the insurer applies the enterprise risk management process described in the own risk and solvency assessment summary report, and that a copy of the report has been provided to the insurer's board of directors or the appropriate committee thereof.(C) An insurer may comply with division (A) of this section by providing the most recent and substantially similar report provided by the insurer or another member of an insurance group of which the insurer is a member to the commissioner of another state or to a supervisor or regulator of a foreign jurisdiction, if that report provides information that is comparable to the information described in the own risk and solvency assessment guidance manual. Any such report in a language other than English must be accompanied by a translation of that report into the English language.
Ohio Rev Code § 3901.377 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3901 | Superintendent of Insurance|Section 3901.377 | Form and Content of Report; Review.

Effective: January 1, 2015|Latest Legislation:  Senate Bill 140 - 130th General Assembly|(A) The own risk and solvency assessment summary report shall be prepared consistent with the own risk and solvency assessment guidance manual, subject to the requirements of division (B) of this section, and all documentation and supporting information shall be maintained and made available for examination upon request of the superintendent of insurance. (B) The superintendent's review of the own risk and solvency assessment summary report, and any additional requests for information, shall be made using similar procedures used in the analysis and examination of multi-state or global insurers and insurance groups.
Ohio Rev Code § 3901.38 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3901 | Superintendent of Insurance|Section 3901.38 | Prompt Payments to Health Care Providers Definitions.

Effective: July 24, 2002|Latest Legislation:  Senate Bill 4 - 124th General Assembly|As used in this section and sections 3901.381 to 3901.3814 of the Revised Code:(A) "Beneficiary" means any policyholder, subscriber, member, employee, or other person who is eligible for benefits under a benefits contract.(B) "Benefits contract" means a sickness and accident insurance policy providing hospital, surgical, or medical expense coverage, or a health insuring corporation contract or other policy or agreement under which a third-party payer agrees to reimburse for covered health care or dental services rendered to beneficiaries, up to the limits and exclusions contained in the benefits contract.(C) "Hospital" has the same meaning as in section 3727.01 of the Revised Code.(D) "Provider" means a hospital, nursing home, physician, podiatrist, dentist, pharmacist, chiropractor, or other health care provider entitled to reimbursement by a third-party payer for services rendered to a beneficiary under a benefits contract.(E) "Reimburse" means indemnify, make payment, or otherwise accept responsibility for payment for health care services rendered to a beneficiary, or arrange for the provision of health care services to a beneficiary.(F) "Third-party payer" means any of the following:(1) An insurance company;(2) A health insuring corporation;(3) A labor organization;(4) An employer;(5) An intermediary organization, as defined in section 1751.01 of the Revised Code, that is not a health delivery network contracting solely with self-insured employers;(6) An administrator subject to sections 3959.01 to 3959.16 of the Revised Code;(7) A health delivery network, as defined in section 1751.01 of the Revised Code;(8) Any other person that is obligated pursuant to a benefits contract to reimburse for covered health care services rendered to beneficiaries under such contract.
Ohio Rev Code § 3901.382 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3901 | Superintendent of Insurance|Section 3901.382 | Electronic Submission of Claims.

Effective: July 24, 2002|Latest Legislation:  Senate Bill 4 - 124th General Assembly|Beginning six months after the date specified in section 262 of the "Health Insurance Portability and Accountability Act of 1996," 110 Stat. 2027, 42 U.S.C.A. 1320d-4, on which a third-party payer is initially required to comply with a standard or implementation specification for the electronic exchange of health information, as adopted or established by the United States secretary of health and human services pursuant to that act, sections 3901.381, 3901.384, 3901.385, 3901.389, 3901.3810, 3901.3811, 3901.3812, and 3901.3813 of the Revised Code apply to a claim submitted to a third-party payer for payment for health care services only if the claim is submitted electronically. A provider and third-party payer may enter into a contractual arrangement under which the third-party payer agrees to process claims that are not submitted electronically because of the financial hardship that electronic submission of claims would create for the provider or any other extenuating circumstance.
Ohio Rev Code § 3901.383 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3901 | Superintendent of Insurance|Section 3901.383 | Contractual Agreements for Payments by Third-Party Payers.

Effective: June 30, 2006|Latest Legislation:  House Bill 530 - 126th General Assembly|(A) A provider and a third-party payer may do either of the following:(1) Enter into a contractual agreement under which time periods shorter than those set forth in section 3901.381 of the Revised Code are applicable to the third-party payer in paying a claim for any amount due for health care services rendered by the provider;(2) Enter into a contractual agreement under which the timing of payments by the third-party payer is not directly related to the receipt of a claim form. The contractual arrangement may include periodic interim payment arrangements, capitation payment arrangements, or other periodic payment arrangements acceptable to the provider and the third-party payer. Under a capitation payment arrangement, the third-party payer shall begin paying the capitated amounts to the beneficiary's primary care provider not later than sixty days after the date the beneficiary selects or is assigned to the provider. Under any other contractual periodic payment arrangement, the contractual agreement shall state, with specificity, the timing of payments by the third-party payer.(B) Regardless of whether a third-party payer is exempted under division (D) of section 3901.3814 from sections 3901.38 and 3901.381 to 3901.3813 of the Revised Code, a provider and the third-party payer, including a third-party payer that provides coverage under the medicaid program, shall not enter into a contractual arrangement under which time periods longer than those provided for in paragraph (c)(1) of 42 C.F.R. 447.46 are applicable to the third-party payer in paying a claim for any amount due for health care services rendered by the provider.
Ohio Rev Code § 3901.384 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3901 | Superintendent of Insurance|Section 3901.384 | Untimely Claim Process.

Effective: July 24, 2002|Latest Legislation:  Senate Bill 4 - 124th General Assembly|(A) Subject to division (B) of this section, a third-party payer that requires timely submission of claims for payment for health care services shall process a claim that is not submitted in a timely manner if a claim for the same services was initially submitted to a different third-party payer or state or federal program that offers health care benefits and that payer or program has determined that it is not responsible for the cost of the health care services. When a claim is submitted later than one year after the last date of service for which reimbursement is sought under the claim, the third-party payer shall pay or deny the claim not later than ninety days after receipt of the claim or, alternatively, pursuant to the requirements of sections 3901.381 to 3901.388 of the Revised Code. The third-party payer must make an election to process such claims either within the ninety-day period or under section 3901.381 of the Revised Code. If the claim is denied, the third-party payer shall notify the provider and the beneficiary. The notice shall state, with specificity, why the third-party payer denied the claim.(B) The third-party payer may refuse to process a claim submitted by a provider if the provider submits the claim later than forty-five days after receiving notice from the different third-party payer or a state or federal program that that payer or program is not responsible for the cost of the health care services, or if the provider does not submit the notice of denial from the different third-party payer or program with the claim. The failure of a provider to submit a notice of denial in accordance with this division shall not affect the terms of a benefits contract.(C) For purposes of this section, both of the following apply:(1) A determination that a third-party payer or state or federal program is not responsible for the cost of health care services includes a determination regarding coordination of benefits, preexisting health conditions, ineligibility for coverage at the time services were provided, subrogation provisions, and similar findings;(2) State and federal programs that offer health care benefits include medicare, medicaid, workers' compensation, the civilian health and medical program of the uniformed services and other elements of the tricare program offered by the United States department of defense, and similar state or federal programs.(D) Any provision of a contractual arrangement entered into between a third-party payer and a provider or beneficiary that is contrary to divisions (A) to (C) of this section is unenforceable.
Ohio Rev Code § 3901.385 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3901 | Superintendent of Insurance|Section 3901.385 | Third-Party Payer - Prohibited Acts.

Effective: July 24, 2002|Latest Legislation:  Senate Bill 4 - 124th General Assembly|A third-party payer shall not do either of the following:(A) Engage in any business practice that unfairly or unnecessarily delays the processing of a claim or the payment of any amount due for health care services rendered by a provider to a beneficiary;(B) Refuse to process or pay within the time periods specified in section 3901.381 of the Revised Code a claim submitted by a provider on the grounds the beneficiary has not been discharged from the hospital or the treatment has not been completed, if the submitted claim covers services actually rendered and charges actually incurred over at least a thirty-day period.
Ohio Rev Code § 3901.386 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3901 | Superintendent of Insurance|Section 3901.386 | Reimbursement Contract - Reimbursements to Be Made Directly to Hospital - Assignment of Benefits.

Effective: July 24, 2002|Latest Legislation:  Senate Bill 4 - 124th General Assembly|(A) Notwithstanding section 1751.13 or division (I)(2) of section 3923.04 of the Revised Code, a reimbursement contract entered into or renewed on or after June 29, 1988, between a third-party payer and a hospital shall provide that reimbursement for any service provided by a hospital pursuant to a reimbursement contract and covered under a benefits contract shall be made directly to the hospital.(B) If the third-party payer and the hospital have not entered into a contract regarding the provision and reimbursement of covered services, the third-party payer shall accept and honor a completed and validly executed assignment of benefits with a hospital by a beneficiary, except when the third-party payer has notified the hospital in writing of the conditions under which the third-party payer will not accept and honor an assignment of benefits. Such notice shall be made annually.(C) A third-party payer may not refuse to accept and honor a validly executed assignment of benefits with a hospital pursuant to division (B) of this section for medically necessary hospital services provided on an emergency basis.
Ohio Rev Code § 3901.387 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3901 | Superintendent of Insurance|Section 3901.387 | Duplicative Claims - Claim Information System.

Effective: July 24, 2002|Latest Legislation:  Senate Bill 4 - 124th General Assembly|(A) When a provider or beneficiary submits a duplicative claim for payment for health care services before the time periods specified in section 3901.381 of the Revised Code have elapsed for the original claim submitted, the third-party payer may deny the duplicative claim. Denials of claims determined to be duplicative by the department of insurance shall not be considered by the department in a market conduct examination of a third-party payer's compliance with section 3901.381 of the Revised Code. The superintendent of insurance shall have the discretion to exclude an original claim in determining a violation under section 3901.381 of the Revised Code.(B)(1) A third-party payer shall establish a system whereby a provider and a beneficiary may obtain information regarding the status of a claim for payment for health care services, provided the claim is not materially deficient. A third-party payer shall inform providers and beneficiaries of the mechanisms that may be used to gain access to the system.(2) If a third-party payer delegates the processing of payments to another entity, the third-party payer shall require the entity to comply with division (B)(1) of this section on behalf of the third-party payer.
Ohio Rev Code § 3901.388 (2021)
2021 Ohio Revised Code|Title 39 | Insurance|Chapter 3901 | Superintendent of Insurance|Section 3901.388 | Payments Considered Final - Overpayment.

Effective: July 24, 2002|Latest Legislation:  Senate Bill 4 - 124th General Assembly|(A) A payment made by a third-party payer to a provider in accordance with sections 3901.381 to 3901.386 of the Revised Code shall be considered final two years after payment is made. After that date, the amount of the payment is not subject to adjustment, except in the case of fraud by the provider.(B) A third-party payer may recover the amount of any part of a payment that the third-party payer determines to be an overpayment if the recovery process is initiated not later than two years after the payment was made to the provider. The third-party payer shall inform the provider of its determination of overpayment by providing notice in accordance with division (C) of this section. The third-party payer shall give the provider an opportunity to appeal the determination. If the provider fails to respond to the notice sooner than thirty days after the notice is made, elects not to appeal the determination, or appeals the determination but the appeal is not upheld, the third-party payer may initiate recovery of the overpayment.When a provider has failed to make a timely response to the notice of the third-party payer's determination of overpayment, the third-party payer may recover the overpayment by deducting the amount of the overpayment from other payments the third-party payer owes the provider or by taking action pursuant to any other remedy available under the Revised Code. When a provider elects not to appeal a determination of overpayment or appeals the determination but the appeal is not upheld, the third-party payer shall permit a provider to repay the amount by making one or more direct payments to the third-party payer or by having the amount deducted from other payments the third-party payer owes the provider.(C) The notice of overpayment a third-party payer is required to give a provider under division (B) of this section shall be made in writing and shall specify all of the following:(1) The full name of the beneficiary who received the health care services for which overpayment was made;(2) The date or dates the services were provided;(3) The amount of the overpayment;(4) The claim number or other pertinent numbers;(5) A detailed explanation of basis for the third-party payer's determination of overpayment;(6) The method in which payment was made, including, for tracking purposes, the date of payment and, if applicable, the check number;(7) That the provider may appeal the third-party payer's determination of overpayment, if the provider responds to the notice within thirty days;(8) The method by which recovery of the overpayment would be made, if recovery proceeds under division (B) of this section.(D) Any provision of a contractual arrangement entered into between a third-party payer and a provider or beneficiary that is contrary to divisions (A) to (C) of this section is unenforceable.