S.D. Admin. R. 20:06:53:65

Current through Register Vol. 50, page 159, June 17, 2024

Section 20:06:53:65 - Independent review organization and health carrier recordkeeping

The independent review organization shall retain the written records required pursuant to § 20:06:53:64 for at least three years.

Each health carrier shall maintain written records in the aggregate, by state and for each type of health benefit plan offered by the health carrier, on all requests for external review that the health carrier receives notice of from the director pursuant to this chapter. Each health carrier required to maintain written records on all requests for external review pursuant to this section shall submit to the director, upon request, a report in the format of Appendix D. The report shall include in the aggregate, by state, and by type of health benefit plan the following information:

(1) The total number of requests for external review; and

(2) From the total number of requests for external review reported under subdivision (1) of this section, the number of requests determined eligible for a full external review.

The director may request additional information to be included within the report or to be provided at an alternate date that relates to the health carrier's compliance with this chapter.

The health carrier shall retain the written records required pursuant to this section for at least three years.

S.D. Admin. R. 20:06:53:65

37 SDR 48, effective 9/22/2010; 37 SDR 241, effective 7/1/2011.

General Authority: SDCL 58-17-87, 58-17H-49, 58-17I-16, 58-18-79.

Law Implemented: SDCL 58-17-87, 58-18-79.