20-2503. Utilization review standards;
applicability; definition


A. The utilization review standards established in this chapter apply to
prospective, concurrent and retrospective utilization review for:


1. Inpatient admissions to hospitals and other inpatient facilities.


2. Outpatient admissions to surgical facilities.


3. Outpatient surgical services provided in a health care provider's office.


4. Medical, surgical and health care services that may be covered by a health care
insurer depending on determinable contingencies, including without limitation outpatient
services, in-office consultations with medical specialists, specialized diagnostic
testing, mental health services, emergency care and inpatient and outpatient hospital
services.


B. For purposes of this section "inpatient admissions" includes inpatient
admissions to all acute medical, surgical, obstetrical, psychiatric and chemical
dependency inpatient services at a licensed hospital or other inpatient facility.