Addresses the burden of prior authorizations on patients and physicians by increasing the transparency in prior authorization requirements, ensuring that payers respond to requests in a timely manner and preventing retroactive denials of authorizations.
Requirements relating to basic benefits
Definitions
Standard Prescription Drug Formulary Template
Prior authorization for health care services – disclosures and notice – determination deadlines – criteria – limits and exceptions – definitions – rules
Group health insurance policy to contain definition of “medically necessary” or “medical necessity”
Internal Review and Independent Utilization Review of Health Insurance Claims