See the bold text below:

Retroactive Denial

Section 33-46-23. Restrictions on Authorizations When Service Timely Rendered

If initial healthcare services are performed within 45 business days of approval of prior authorization, the insurer shall not revoke, limit, condition, or restrict such authorization, unless such prior authorization is for a Schedule II controlled substance or there is a billing error, fraud, material misrepresentation, or loss of coverage.

State Medical Necessity Decisions-Deadlines

Section 33-46-26. Timely Notification of Prior Authorization or Adverse Determination

Effective January 1, 2022, until December 31, 2022, if an insurer requires prior authorization of a healthcare service, a private review agent or utilization review entity shall notify the covered person’s healthcare provider, or such provider’s appropriately qualified designee, of any prior authorization or adverse determination within 15 calendar days of obtaining all necessary information to make such authorization or adverse determination. Effective January 1, 2023, if an insurer requires prior authorization of a healthcare service, a private review agent or utilization review entity shall notify the covered person’s healthcare provider, or such provider’s appropriately qualified designee, of any prior authorization or adverse determination within 7 calendar days of obtaining all necessary information to make such authorization or adverse determination.

Section 33-46-27. Notification Time for Prior Authorization or Adverse Determination

A private review agent or utilization review entity shall render a prior authorization or adverse determination concerning urgent healthcare services and notify such person’s healthcare provider, or such provider’s appropriately qualified designee, of that prior authorization or adverse determination no later than 72 hours after receiving all information needed to complete the review of the requested healthcare services.

Section 33-46-28. Honoring of Prior Authorizations

(a) Upon receipt of information documenting a prior authorization from a covered person or from a covered person’s healthcare provider, a private review agent or utilization review entity, for at least the initial 30 days of such person’s new coverage, shall honor a prior authorization for a covered healthcare service granted to him or her from a previous private review agent or utilization review entity even if approval criteria or products of a healthcare plan have changed or such person is covered under a new healthcare plan, so long as the former criteria, products, or plans are not binding upon a new insurer.

(b) During the time period described in subsection (a) of this Code section, a private review agent or utilization review entity may perform its own review to grant a prior authorization.

(c) If there is a change in coverage of, or approval criteria for, a previously authorized healthcare service, the change in coverage or approval criteria shall not affect a covered person who received prior authorization before the effective date of such change for the remainder of the covered person’s plan year so long as such person remains covered by the same insurer.

(d) A private review agent or utilization review entity shall continue to honor a prior authorization it has granted to a covered person in accordance with this Code section.

Section 33-46-29. Noncompliance Resulting in Automatic Authorization

Each violation by a private review agent or utilization review entity of deadline or other requirements specified in this chapter shall result in the automatic authorization of healthcare services under review by such private review agent or utilization review entity if such noncompliance is related to such services. Notwithstanding the foregoing, noncompliance based on a de minimis violation that does not cause, or is not likely to cause, prejudice or harm to the covered person shall not result in the automatic authorization of such healthcare services, so long as the insurer demonstrates that the violation occurred due to good cause or due to matters beyond the control of the insurer and that such violation occurred in the context of an ongoing good faith exchange of information between the insurer and the covered person, or, if applicable, the covered person’s healthcare provider or authorized representative.

See https://law.justia.com/codes/georgia/2022/title-33/chapter-46/article-2/