S.D. Admin. R. 67:16:41:15

Current through Register Vol. 50, page 151, June 10, 2024

Section 67:16:41:15 - Utilization review

Utilization review may be conducted on the following levels:

(1) Computerized claim processing;

(2) Postpayment review; and

(3) Peer review.

A peer review entity appointed by the department shall review claims to determine and ensure the appropriate quality, quantity, and medical necessity of mental health services provided.

S.D. Admin. R. 67:16:41:15

22 SDR 6, effective 7/26/1995.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.