(a) On and after January 1, 2014, to establish uniformity in the submission of prior authorization and nonmedical review forms, a healthcare insurer shall utilize only a single standardized prior authorization and nonmedical review form for obtaining approval in written or electronic form for prescription drug benefits.
(b) A healthcare insurer may make the form required under subsection (a) of this section accessible through multiple computer operating systems.
(c) The form required under subsection (a) of this section shall:
(1) Not exceed two (2) pages; and
(2) Be designed to be submitted electronically from a prescribing provider to a healthcare insurer.
(d) This section does not prohibit prior authorization or nonmedical review by verbal means without a form.
(e) If a healthcare insurer fails to use or accept the form developed under this section or fails to respond as soon as reasonably possible, but no later than one (1) business day for prior authorizations for urgent healthcare services, sixty (60) minutes for emergency healthcare services, or seventy-two (72) hours for all other services, after receipt of a completed prior authorization or nonmedical review request using the form developed under this section, the prior authorization or nonmedical review request is deemed authorized or approved.
(f) (1) On and after January 1, 2014, each healthcare insurer shall submit its prior authorization and nonmedical review form to the State Insurance Department to be kept on file.
(2) A copy of a subsequent replacement or modification of a healthcare insurer's prior authorization and nonmedical review form shall be filed with the department within fifteen (15) days before the form is used or before implementation of the replacement or modification.
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 23-99-1114Last modified: November 15, 2016