Section 58-17C-76 - Urgent care requests--Notice of determination--Failure to submit necessaryinformation grounds for denial of certification--Notice of adversedeterminations. - South-dakota Statutes

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Statutes > South-dakota > Title-58 > Chapter-17c > Statute-58-17c-76

58-17C-76. Urgent care requests--Notice of determination--Failure to submit necessary information grounds for denial of certification--Notice of adverse determinations. The health carrier shall notify the covered person or, if applicable, the covered person's authorized representative of its determination with respect to the urgent care request as soon as possible, but in no event more than forty-eight hours after the earlier of:
(1) The health carrier's receipt of the requested specified information; or
(2) The end of the period provided for the covered person or, if applicable, the covered person's authorized representative to submit the requested specified information.
If the covered person or the covered person's authorized representative fails to submit the information before the end of the period of the extension, as specified in § 58-17C-75, the health carrier may deny the certification of the requested benefit. If the health carrier's determination is an adverse determination, the health carrier shall provide notice of the adverse determination in accordance with § 58-17C-52.

Source: SL 2003, ch 250, § 21.

State Codes and Statutes

Statutes > South-dakota > Title-58 > Chapter-17c > Statute-58-17c-76

58-17C-76. Urgent care requests--Notice of determination--Failure to submit necessary information grounds for denial of certification--Notice of adverse determinations. The health carrier shall notify the covered person or, if applicable, the covered person's authorized representative of its determination with respect to the urgent care request as soon as possible, but in no event more than forty-eight hours after the earlier of:
(1) The health carrier's receipt of the requested specified information; or
(2) The end of the period provided for the covered person or, if applicable, the covered person's authorized representative to submit the requested specified information.
If the covered person or the covered person's authorized representative fails to submit the information before the end of the period of the extension, as specified in § 58-17C-75, the health carrier may deny the certification of the requested benefit. If the health carrier's determination is an adverse determination, the health carrier shall provide notice of the adverse determination in accordance with § 58-17C-52.

Source: SL 2003, ch 250, § 21.

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State Codes and Statutes

Statutes > South-dakota > Title-58 > Chapter-17c > Statute-58-17c-76

58-17C-76. Urgent care requests--Notice of determination--Failure to submit necessary information grounds for denial of certification--Notice of adverse determinations. The health carrier shall notify the covered person or, if applicable, the covered person's authorized representative of its determination with respect to the urgent care request as soon as possible, but in no event more than forty-eight hours after the earlier of:
(1) The health carrier's receipt of the requested specified information; or
(2) The end of the period provided for the covered person or, if applicable, the covered person's authorized representative to submit the requested specified information.
If the covered person or the covered person's authorized representative fails to submit the information before the end of the period of the extension, as specified in § 58-17C-75, the health carrier may deny the certification of the requested benefit. If the health carrier's determination is an adverse determination, the health carrier shall provide notice of the adverse determination in accordance with § 58-17C-52.

Source: SL 2003, ch 250, § 21.