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.
History. Code 1981, § 33-46-26 , enacted by Ga. L. 2021, p. 629, § 2/SB 80.
Structure Georgia Code
Chapter 46 - Certification of Private Review Agents
Article 2 - Prior Authorizations
§ 33-46-20. Prior Authorization Requirements Posted on Website; Statistical Reporting
§ 33-46-22. Review of Appeals by Appropriate Healthcare Provider
§ 33-46-23. Restrictions on Authorizations When Service Timely Rendered
§ 33-46-24. Medically Necessary Unanticipated Emergency or Urgent Healthcare Services
§ 33-46-26. Timely Notification of Prior Authorization or Adverse Determination
§ 33-46-27. Notification Time for Prior Authorization or Adverse Determination
§ 33-46-28. Honoring of Prior Authorizations
§ 33-46-29. Noncompliance Resulting in Automatic Authorization
§ 33-46-30. Mandatory Compliance
§ 33-46-31. Role of Commissioner; Compliance Enforced by Department of Community Health