Purpose

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The purpose of this subchapter is to:

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

  2. (2) Foster greater coordination between payors and providers conducting utilization review activities;

  3. (3) Protect patients, business, and providers by ensuring that private review agents are qualified to perform utilization activities and to make informed decisions on the appropriateness of medical care; and

  4. (4) Ensure that private review agents maintain the confidentiality of medical records.


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