TITLE 27
Insurance

CHAPTER 27-18.9
Benefit Determination and Utilization Review Act [Effective January 1, 2018.]

SECTION 27-18.9-1


§ 27-18.9-1. Purpose of chapter. [Effective January 1, 2018.].

(a) The purpose of this chapter is to:

(1) Promote the delivery of quality health care in a cost-effective manner;

(2) Foster greater coordination between health care providers, patients, health care entities, health benefit plans and utilization-review entities to ensure public health well-being;

(3) Protect beneficiaries, businesses, and providers by ensuring that review agents are qualified to perform review activities and to make informed decisions on the medical necessity and appropriateness of medical care;

(4) Ensure that review agents maintain the confidentiality of medical records in accordance with applicable state and federal laws; and

(5) Interface and maintain compliance with federal benefit determination and adverse benefit determination requirements.

(b) Nothing in this chapter is intended to prohibit or discourage the health insurance commissioner from consulting or collaborating with the department of health, or any other state or federal agency, to the extent the commissioner in his or her discretion determines such consultation and/or collaboration is necessary and/or appropriate for the administration and enforcement of this chapter.

History of Section.
(P.L. 2017, ch. 302, art. 5, § 5.)