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Certification of Agents and Utilization Review Process
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Utilization Review and External Appeal
Certification of Agents and Utilization Review Process
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Section
4900
Definitions.
Section
4901
Registration of Utilization Review Agents.
Section
4902
Utilization Review Programs Standards.
Section
4903
Utilization Review Determinations.
Section
4904
Appeal of Adverse Determinations by Utilization Review Agents.
Section
4905
Required and Prohibited Practices.
Section
4906
Waiver.
Section
4907
Rights and Remedies.
Section
4908
Applicability to Erisa Plans.