Chapter 15. Utilization Review
Article 1. General Provisions
- § 20-2501. Definitions; Scope
- § 20-2502. Utilization Review Activities; Exemptions
- § 20-2503. Utilization Review Standards; Applicability; Definition
- § 20-2504. Utilization Review Agents; Certification; Rules
- § 20-2505. Application For Certification
- § 20-2506. Certification; Responsibilities of Department; Cost Recovery
- § 20-2507. Certificates; Renewal
- § 20-2508. Denial, Suspension Or Revocation of Certificates; Hearing; Civil Penalties
- § 20-2509. Confidentiality
- § 20-2510. Health Care Insurers Requirements; Medical Directors
- § 20-2511. Violation; Injunctive Relief
Article 2. Health Care Appeals
- § 20-2530. Definitions
- § 20-2531. Applicability; Requirements
- § 20-2532. Utilization Review Standards and Criteria; Requirements
- § 20-2533. Denial; Levels of Review; Disclosure; Additional Time After Service By Mail; Review Process
- § 20-2534. Expedited Medical Review; Expedited Appeal
- § 20-2535. Informal Reconsideration
- § 20-2536. Formal Appeal
- § 20-2537. External Independent Review; Expedited External Independent Review
- § 20-2538. Independent Review Organizations
- § 20-2539. Rules
- § 20-2540. Health Care Appeals Fund
- § 20-2541. Health Care Insurer Fee