Transcription of UTILIZATION REVIEW AND BENEFIT …
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UTILIZATION REVIEW AND BENEFIT …
Model Regulation Service April 2012 2012 National Association of Insurance Commissioners 73-1 UTILIZATION REVIEW AND BENEFIT DETERMINATION MODEL ACT Table of Contents Section 1. Title Section 2. Purpose and Intent Section 3. Definitions Section 4. Applicability and Scope Section 5. Corporate Oversight of UTILIZATION REVIEW Program Section 6. Contracting Section 7. Scope and Content of UTILIZATION REVIEW Program Section 8. Operational Requirements Section 9. Procedures for Standard UTILIZATION REVIEW and BENEFIT Determinations Section 10. Procedures for Expedited UTILIZATION REVIEW and BENEFIT Determinations Section 11.
Model Regulation Service—April 2012 © 2012 National Association of Insurance Commissioners 73-3 F. “Clinical peer” means a physician or other health care professional who holds a
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