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58-17H-45 Urgent care requests--Notice of determination--Failure to submit necessary information as ...
     58-17H-45.   Urgent care requests--Notice of determination--Failure to submit necessary information as grounds for denial of certification. The health carrier shall notify the covered person or, if applicable, the covered person's authorized representative, of its determination with respect to the urgent care request as soon as possible, but in no event more than forty-eight hours after the earlier of:
             (1)      The health carrier's receipt of the requested specified information; or
             (2)      The end of the period provided for the covered person or, if applicable, the covered person's authorized representative, to submit the requested specified information.
     If the covered person or the covered person's authorized representative fails to submit the information before the end of the period of the extension, as specified in § 58-17H-44, the health carrier may deny the certification of the requested benefit. If the health carrier's determination is an adverse determination, the health carrier shall provide notice of the adverse determination in accordance with § 58-17H-32. (SL 2012, ch 239, § 1 provides: "The provisions of chapter 219 of the 2011 Session Laws shall be deemed repealed if the Patient Protection and Affordable Care Act, Pub. L. No. 111-148, 124 Stat. 119 (2010), as amended by the Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010) is found to be unconstitutional in its entirety by a final decision of a federal court of competent jurisdiction and all appeals exhausted or time for appeals elapsed.")

Source: SL 2011, ch 219, § 70.


Chapter 58-17H

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