N.D. Cent. Code § 26.1-26.4-03

Current through 2023 Legislative Sessions

Section 26.1-26.4-03 - Certification

A utilization review agent may not conduct utilization review in this state unless the utilization review agent has certified to the commissioner in writing that the agent is in compliance with section 26.1-26.4-04. Certification must be made annually on or before March first of each calendar year. In addition, a utilization review agent must file the following information:

1. The name, address, telephone number, and normal business hours of the utilization review agent.

2. The name and telephone number of a person for the commissioner to contact.

3. A description of the appeal procedures for utilization review determinations.

4. A list of the third-party payers for whom the private review agent is performing utilization review in the state.

A provider may request that a utilization review agent furnish the provider with the medical review criteria to be used in evaluating proposed or delivered health care services. Any material changes in the information filed in accordance with this section must be filed with the commissioner within thirty days of the change.

N.D.C.C. § 26.1-26.4-03