If the Department of Human Services requires a provider to justify the medical necessity of a service through prior authorization, the department shall not later take the position that the services were not medically necessary, unless the retrospective review establishes that:
(1) The previous authorization was based upon misrepresentation by act or omission;
(2) The services billed were not provided; or
(3) An unexpected change occurred that rendered the prior-authorized care not medically necessary.
Section: Previous 20-77-1702 20-77-1703 20-77-1704 20-77-1705 20-77-1706 20-77-1707 20-77-1708 20-77-1709 20-77-1710 20-77-1711 20-77-1712 20-77-1713 20-77-1714 20-77-1715 NextLast modified: November 15, 2016