Article 49 - UTILIZATION REVIEW AND EXTERNAL APPEAL
- Title 1 - (4900 - 4908) REGISTRATION OF AGENTS AND REVIEW PROCESS
- 4900 - Definitions.
- 4901 - Reporting requirements for utilization review agents.
- 4902 - Utilization review program standards.
- 4903 - Utilization review determinations.
- 4904 - Appeal of adverse determinations by utilization review agents.
- 4905 - Required and prohibited practices.
- 4906 - Waiver.
- 4907 - Rights and remedies.
- 4908 - Applicability to ERISA Plans.
- Title 2 - (4910 - 4917) RIGHT TO EXTERNAL APPEAL
- 4910 - Right to external appeal established.
- 4911 - Powers of the superintendent.
- 4912 - Standards for certification.
- 4913 - Conflict of interest.
- 4914 - Procedures for external appeals of adverse determinations.
- 4915 - Prohibited practices.
- 4916 - Oversight and surveillance of the external appeal process.
- 4917 - Hold harmless.