Internal claims and appeals and external review processes

Appeals process

Claims Procedure

Internal claims and appeals and external review processes; Internal claims and appeals and external review processes (temporary)

Duties of insurer or private review agent performing utilization reviews — Requirement for registration — Consequences of insurer’s failure to make timely utilization review determination — Requirement that insurer or private review agent submit changes to the department — Requirement that private review agent provide timely notice of entities for whom it is providing review.

Internal claims and appeals procedures

Minimum standards of utilization review agents