Rule 30-2301-1.59 - BOARD REGULATION NUMBER 59-LICENSURE OF INDIVIDUALS PERFORMING DENTAL UTILIZATION REVIEW Error! Bookmark not defined.
Purpose: To stipulate Mississippi licensure requirements for individuals performing dental utilization review.
Any program of utilization review with regard to dental care services provided in this State shall comply with the following:
1. No determination adverse to a patient or to any dental provider shall be made on any question relating to the necessity or justification for dental care services without prior evaluation and concurrence in the adverse determination by a dentist licensed to practice in Mississippi. The reviewing dentist who made the adverse determination shall discuss the reasons for any adverse determination with the affected dentist provider, if the provider so requests. The reviewing dentist shall comply with this request within fourteen (14) calendar days of being notified of a request. An adverse determination by a reviewing dentist shall not be grounds for any disciplinary action against the dentist by the Mississippi State Board of Dental Examiners.2. Any determination regarding dental care services rendered or to be rendered to a patient which may result in a denial of third-party reimbursement or a denial of pre-certification for that service shall include the evaluation, findings, and concurrence of a reviewing dentist trained in the relevant specialty or sub-specialty, if requested by the patient's dentist, to make a final determination that care rendered or to be rendered was, is, or may be inappropriate.3. The requirement in this section that a reviewing dentist who makes the evaluation and concurrence in the adverse determination must be licensed to practice in Mississippi shall not apply to the Comprehensive Health Insurance Risk Pool Association or its policyholders.30 Miss. Code. R. 2301-1.59
Miss. Code Ann. § 73-9-19.Regulation Fifty-Nine adopted by the Mississippi State Board of Dental Examiners December 8, 2000.