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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 |