33-33-201. Standards for utilization review organizations. (1) A utilization review organization that conducts utilization reviews in this state for property and casualty insurers shall register with the commissioner prior to performing utilization reviews. The commissioner shall place a utilization review organization on the register when the utilization review organization provides information that establishes that the utilization review organization meets the standards set forth in this section. The commissioner shall remove from the register a utilization review organization that fails to meet the standards set forth in this section.
(2) Utilization review organizations may use only licensed or certified health care professionals to conduct utilization reviews.
(3) Utilization reviews must be conducted by health care professionals who are licensed or certified in the same specialty as the provider whose treatment is being received by the insured or by a health care professional who is qualified to render the treatment being reviewed.
(4) Utilization review organizations shall comply with all applicable state or federal medical privacy laws.
(5) Utilization review evaluations must use generally accepted standards for treatment of the illness, injury, or condition that is being reviewed.
(6) Utilization review opinions must be signed by the health care professional performing the review.
(7) A utilization review organization may not base its fees or charges on any recommendation for a reduction in payment under an insurance contract or on a percentage of claim savings.
History: En. Sec. 4, Ch. 335, L. 2001.