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Part 1. General Provisions
33-32-101. Purpose - 33-32-101. Purpose. The legislature finds and declares that it is...
33-32-102. Definitions - 33-32-102. Definitions. As used in this chapter, the following definitions...
33-32-103. Utilization review plan - 33-32-103. Utilization review plan. An entity covered under the provisions...
33-32-104. Preemption by federal law - 33-32-104. Preemption by federal law. If any provision of this...
33-32-105. Application -- exemptions - 33-32-105. Application -- exemptions. (1) Except as provided in subsections...
33-32-106. Disclosure of utilization review requirements -- drug benefit information - 33-32-106. Disclosure of utilization review requirements -- drug benefit information....
33-32-107. Length of prior authorization - 33-32-107. Length of prior authorization. A certification by a utilization...
Part 2. Utilization Review -- Conduct
33-32-201. Repealed - 33-32-201. Repealed. Sec. 40, Ch. 428, L. 2015. History: En....
33-32-202. Commissioner not to approve or disapprove plans - 33-32-202. Commissioner not to approve or disapprove plans. Nothing in...
33-32-203. Repealed - 33-32-203. Repealed. Sec. 40, Ch. 428, L. 2015. History: En....
33-32-204. Repealed - 33-32-204. Repealed. Sec. 40, Ch. 428, L. 2015. History: En....
33-32-205. Corporate oversight of utilization review program - 33-32-205. Corporate oversight of utilization review program. A health insurance...
33-32-206. Responsibility for contracted services - 33-32-206. Responsibility for contracted services. Whenever a health insurance issuer...
33-32-207. Health insurance issuer duties for utilization review - 33-32-207. Health insurance issuer duties for utilization review. (1) A...
33-32-208. Operational requirements - 33-32-208. Operational requirements. (1) A utilization review program must use...
33-32-209. and 33-32-210 reserved - 33-32-209 and 33-32-210 reserved.
33-32-211. Procedures for standard utilization review and benefit determinations -- notices - 33-32-211. Procedures for standard utilization review and benefit determinations --...
33-32-212. Procedures for expedited utilization review and benefit determinations - 33-32-212. Procedures for expedited utilization review and benefit determinations. (1)...
33-32-213. and 33-32-214 reserved - 33-32-213 and 33-32-214 reserved.
33-32-215. Emergency services - 33-32-215. Emergency services. (1) When conducting a utilization review or...
33-32-216. Confidentiality - 33-32-216. Confidentiality. A health insurance issuer and its designee shall...
33-32-217. Disclosure - 33-32-217. Disclosure. (1) In the certificate of coverage and member...
Part 3. Grievance Procedures
33-32-301. Short title - 33-32-301. Short title. The provisions of Title 33, chapter 32,...
33-32-302. Applicability and scope - 33-32-302. Applicability and scope. (1) Except as provided in subsection...
33-32-303. Purpose - 33-32-303. Purpose. The purpose of this part is to provide...
33-32-304. and 33-32-305 reserved - 33-32-304 and 33-32-305 reserved.
33-32-306. Grievance reporting and recordkeeping requirements -- definition - 33-32-306. Grievance reporting and recordkeeping requirements -- definition. (1) (a)...
33-32-307. Grievance review procedures - 33-32-307. Grievance review procedures. (1) Except as specified in 33-32-309,...
33-32-308. Grievances involving adverse determination - 33-32-308. Grievances involving adverse determination. (1) Within 180 days after...
33-32-309. Expedited review of grievance involving adverse determination - 33-32-309. Expedited review of grievance involving adverse determination. (1) A...
Part 4. External Review
33-32-401. Purpose - 33-32-401. Purpose. The purpose of this part is to provide...
33-32-402. Definitions for external review - 33-32-402. Definitions for external review. For the purposes of this...
33-32-403. Notice of right to external review - 33-32-403. Notice of right to external review. (1) A health...
33-32-404. Request for external review - 33-32-404. Request for external review. (1) Except for a request...
33-32-405. Exhaustion of internal grievance process - 33-32-405. Exhaustion of internal grievance process. (1) Except as provided...
33-32-406. through 33-32-409 reserved - 33-32-406 through 33-32-409 reserved.
33-32-410. Standard external review - 33-32-410. Standard external review. (1) Within 120 days after the...
33-32-411. Expedited external review - 33-32-411. Expedited external review. (1) Except as provided in subsection...
33-32-412. External review of adverse determinations for experimental or investigational treatment -- expedited external review - 33-32-412. External review of adverse determinations for experimental or investigational...
33-32-413. and 33-32-414 reserved - 33-32-413 and 33-32-414 reserved.
33-32-415. Binding nature of external review decisions - 33-32-415. Binding nature of external review decisions. (1) An external...
33-32-416. Approval of independent review organizations -- renewal - 33-32-416. Approval of independent review organizations -- renewal. (1) The...
33-32-417. Minimum qualifications for independent review organizations - 33-32-417. Minimum qualifications for independent review organizations. (1) To be...
33-32-418. Liability limits for independent review organization - 33-32-418. Liability limits for independent review organization. (1) Except as...
33-32-419. Fees - 33-32-419. Fees. (1) An application for approval of an independent...
33-32-420. reserved - 33-32-420 reserved.
33-32-421. External review reporting requirements - 33-32-421. External review reporting requirements. (1) An independent review organization...
33-32-422. Funding of external review - 33-32-422. Funding of external review. The health insurance issuer against...
33-32-423. Disclosure requirements - 33-32-423. Disclosure requirements. (1) Each health insurance issuer shall include...