No certificate is required for those private review agents conducting general in-house utilization review for hospitals, home health agencies, preferred provider organizations or other managed care entities, clinics, private physician offices or any other health facility or entity, so long as the review does not result in the approval or denial of payment for hospital or medical services for a particular case. Such general in-house utilization review is completely exempt from the provisions of this chapter.
Structure Mississippi Code
Chapter 83 - Utilization Review of Availability of Hospital Resources and Medical Services
§ 41-83-5. Certificate requirement for general in-house utilization review; exemptions
§ 41-83-9. Submission of information in conjunction with application
§ 41-83-15. Reporting requirements to evaluate and determine compliance
§ 41-83-17. Disclosure or publication of information; consent or authorization; court order
§ 41-83-19. Penalties for violations
§ 41-83-21. Certification of need of immediate hospital care; prima facie evidence