20-2506. Certification; responsibilities of department; cost recovery
A. The director shall examine the affairs, transactions, accounts and records of each utilization review agent before issuing an initial certificate and as often as the director deems it necessary in order to determine if a utilization review agent is in compliance with this chapter. The department shall not make any determination of quality of care, appropriateness of utilization review recommendations or medical necessity relating to any plan of care or treatment.
B. All examination and examination related expenses shall be charged to the utilization review agent and shall be paid by the director out of the insurance examiners' revolving fund in accordance with section 20-159.
C. The director may use independent contract examiners pursuant to sections 20-148 and 20-149 to perform the examinations under this section.
D. Any expenses of examinations not paid by the utilization review agent within thirty days of the billing of the examination expenses shall be paid by the health care insurer that used the services or that contracted with the utilization review agent. If more than one health care insurer used the services of or contracted with a utilization review agent each health care insurer shall pay an equal share of the uncollected expenses.
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