Rule 20:06:53:17 Effect of failure to act on external review process.
20:06:53:17. Effect of failure
to act on external review process. The failure by the health carrier or its
utilization review organization to provide the documents and information within
the time specified in § 20:06:53:16 may not delay the conduct of the
external review except as follows:
the health carrier or its utilization review organization fails to provide the
documents and information within the time specified in § 20:06:53:16, the
assigned independent review organization may terminate the external review and
make a decision to reverse the adverse determination or final adverse
one business day after making the decision under subdivision (1), the
independent review organization shall notify the covered person, if applicable,
the covered person's authorized representative, the health carrier, and the
Source: 37 SDR 48, effective September
22, 2010; 37 SDR 241, effective July 1, 2011
General Authority: SDCL 58-17-87, 58-17H-49, 58-17I-16, 58-18-79.
Law Implemented: SDCL 58-17-87, 58-18-79.
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