(a) By April 1, 2022, and each April 1 thereafter, a health plan company must post on the health plan company's public website the following data for the immediately preceding calendar year for each commercial product:
(1) the number of prior authorization requests for which an authorization was issued;
(2) the number of prior authorization requests for which an adverse determination was issued and sorted by: (i) health care service; (ii) whether the adverse determination was appealed; and (iii) whether the adverse determination was upheld or reversed on appeal;
(3) the number of prior authorization requests that were submitted electronically and not by facsimile or email or other method pursuant to section 62J.497; and
(4) the reasons for prior authorization denial including but not limited to:
(i) patient did not meet prior authorization criteria;
(ii) incomplete information submitted by the provider to the utilization review organization;
(iii) change in treatment program; and
(iv) the patient is no longer covered by the plan.
(b) All information posted under this section must be written in easily understandable language.
2020 c 114 art 1 s 20
Structure Minnesota Statutes
Chapters 59A - 79A — Insurance
Chapter 62M — Utilization Review Of Health Care
Section 62M.01 — Citation, Jurisdiction, And Scope.
Section 62M.03 — Compliance With Standards.
Section 62M.04 — Standards For Utilization Review Performance.
Section 62M.05 — Procedures For Review Determination.
Section 62M.06 — Appeals Of Adverse Determinations.
Section 62M.07 — Prior Authorization Of Services.
Section 62M.072 — Use Of Evidence-based Standards.
Section 62M.08 — Confidentiality.
Section 62M.09 — Staff And Program Qualifications.
Section 62M.10 — Accessibility And On-site Review Procedures.
Section 62M.11 — Complaints To Commerce Or Health.
Section 62M.12 — Prohibition Of Inappropriate Incentives.
Section 62M.13 — Severability.
Section 62M.14 — Effect Of Compliance.
Section 62M.15 — Applicability Of Other Chapter Requirements.
Section 62M.17 — Continuity Of Care; Prior Authorizations.
Section 62M.18 — Annual Posting On Website; Prior Authorizations.