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ARTICLE 49. UTILIZATION REVIEW AND EXTERNAL APPEAL


Title I. Registration of agents and review process (§§4900-4908).

§4900 . Definitions.

§4901 . Reporting requirements for utilization review agents.

§4902 . Utilization review program standards.

§4903 . Utilization review determinations.

§4904 . Appeal of adverse determinations by utilization review agents.

§4905 . Required and prohibited practices.

§4906 . Waiver.

§4907 . Rights and remedies.

§4908 . Applicability to ERISA Plans.


Title II. Right to external appeal (§§4910-4916).

§4910 . Right to external appeal established.

§4911 . Powers of the superintendent.

§4912 . Standards for certification.

§4913 . Conflict of interest.

§4914 . Procedures for external appeals of adverse determinations.

§4915 . Prohibited practices.

§4916 . Oversight and surveillance of the external appeal process.
Source Data downloaded: 2009-04-12 17: 04: 17;       Processed: 2009-05-08 15: 36: 38


   
©2009 Paul Margus, FSA, MAAA