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Rule 20:06:53:26 Director assignment of independent review organization for expedited reviews.

          20:06:53:26.  Director assignment of independent review organization for expedited reviews. Upon receipt of a notice that the request meets the reviewability requirements, the director immediately shall assign an independent review organization to conduct the expedited external review from the list of approved independent review organizations compiled and maintained by the director pursuant to §§ 20:06:53:55 and 20:06:53:56. The director shall immediately notify the health carrier of the name of the assigned independent review organization.

 

          Upon receipt of the notice from the director of the name of the independent review organization assigned to conduct the expedited external review pursuant to this section, the health carrier or its designee utilization review organization shall provide or transmit all necessary documents and information considered in making the adverse determination or final adverse determination to the assigned independent review organization electronically or by telephone or facsimile or any other available expeditious method.

 

          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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