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Rule 20:06:53:24 Notifications upon request for expedited external review.

          20:06:53:24.  Notifications upon request for expedited external review. Upon receipt of a request for an expedited external review, the director immediately shall send a copy of the request to the health carrier. Immediately upon receipt of the request from the director, the health carrier shall determine whether the request meets the reviewability requirements set forth in § 20:06:53:12. The health carrier shall immediately notify the director and the covered person and, if applicable, the covered person's authorized representative of its eligibility determination.

 

          The notice of initial determination shall include a statement informing the covered person and, if applicable, the covered person's authorized representative that a health carrier's initial determination that an external review request is ineligible for review may be appealed to the director.

 

          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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