(a) (1) A utilization review entity shall post all of its prior authorization and nonmedical review requirements and restrictions, including any written clinical criteria, on the public part of its website.
(2) The information described in subdivision (a)(1) of this section shall be explained in detail and in clear and ordinary terms.
(b) Before a utilization review entity implements a new or amended prior authorization or nonmedical review requirement or restriction as described in subdivision (a)(1) of this section, the utilization review entity shall update its website to reflect the new or amended requirement or restriction.
(c) Before implementing a new or amended prior authorization or nonmedical review requirement or restriction, a utilization review entity shall provide contracted healthcare providers written notice of the new or amended requirement or restriction at least sixty (60) days before implementation of the new or amended requirement or restriction.
(d) (1) A utilization review entity shall make statistics available regarding prior authorization approvals and denials and nonmedical approvals and denials on its website in a readily accessible format.
(2) The utilization review entity shall include categories for:
(A) Physician specialty;
(B) Medication or a diagnostic test or procedure;
(C) Indication offered; and
(D) Reason for denial.
Section: Previous 23-99-1102 23-99-1103 23-99-1104 23-99-1105 23-99-1106 23-99-1107 23-99-1108 23-99-1109 23-99-1110 23-99-1111 23-99-1112 23-99-1113 23-99-1114 NextLast modified: November 15, 2016