Internal claims and appeals and external review processes

Appeals process

Claims Procedure

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

Policies with prior authorization requirement provisions