Section 45-06-10-02 - Subsequent determination after initial appeal1. After an initial appeal to reverse a determination regarding hospital, medical, or other health care services is unsuccessful, a subsequent determination which may result in denial of third-party reimbursement or denial of precertification for service must include the evaluation, findings, and concurrence of a physician or licensed practitioner trained in the relevant specialty to make a final determination that care provided or to be provided was, is, or may be medically inappropriate. 2. A physician or licensed practitioner must hold a valid, current professional license issued by an appropriate professional board. 3. Compensation of a physician or licensed practitioner giving an opinion in regard to any determination under subsection 1 may not be dependent in any way upon the result of the final determination. N.D. Admin Code 45-06-10-02
Effective September 1, 1994.General Authority: NDCC 26.1-01-08, 28-32-02
Law Implemented: NDCC 26.1-26.4-04