HEALTH CARE UTILIZATION REVIEW
- Section 376.1350 - Definitions
- Section 376.1353 - Utilization review activities monitored
- Section 376.1356 - Utilization review entity monitored, when
- Section 376.1359 - Written utilization program implemented, filed with the director
- Section 376.1361 - Documented clinical review criteria used in a utilization program - medical director qualifications - compensation of utilization review services
- Section 376.1363 - Utilization review decisions, procedures
- Section 376.1364 - Unique confirmation number required, prior authorization review - secure electronic transmission for prior authorizations - single cover page, contents
- Section 376.1365 - Reconsideration of an adverse determination, when
- Section 376.1367 - Emergency services benefit determination, coverage required, when
- Section 376.1369 - Certification of compliance, when
- Section 376.1372 - Certification and member handbook to include utilization review procedures - website or provider portal, prior authorization requirements available on
- Section 376.1375 - Registry of grievances maintained, procedures - definitions
- Section 376.1378 - Grievances and certificate of compliance filed with the director, when
- Section 376.1382 - First- and second-level grievance review for managed care plans, first-level procedures
- Section 376.1385 - Second-level review procedures
- Section 376.1387 - Appeals of grievances determined by the director
- Section 376.1389 - Expedited grievance review procedure