Section 58-17C-91 - Standard review--Required contents of written decision. - South-dakota Statutes

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58-17C-91. Standard review--Required contents of written decision. The written decision issued pursuant to § 58-17C-90 shall contain:
(1) The titles and qualifying credentials of the person or persons participating in the standard review process (the reviewers);
(2) A statement of the reviewers' understanding of the covered person's grievance;
(3) The reviewers' decision in clear terms and the contract basis in sufficient detail for the covered person to respond further to the health carrier's position;
(4) A reference to the evidence or documentation used as the basis for the decision;
(5) If applicable, a statement indicating:
(a) A description of the process to obtain an additional review of the standard review decision if the covered person wishes to request a voluntary second level review pursuant to § 58-17C-85; and
(b) The written procedures governing the voluntary review, including any required time frame for the review; and
(6) Notice of the covered person's right, at any time, to contact the Division of Insurance, including the telephone number and address of the Division of Insurance.

Source: SL 2003, ch 250, § 42.

State Codes and Statutes

Statutes > South-dakota > Title-58 > Chapter-17c > Statute-58-17c-91

58-17C-91. Standard review--Required contents of written decision. The written decision issued pursuant to § 58-17C-90 shall contain:
(1) The titles and qualifying credentials of the person or persons participating in the standard review process (the reviewers);
(2) A statement of the reviewers' understanding of the covered person's grievance;
(3) The reviewers' decision in clear terms and the contract basis in sufficient detail for the covered person to respond further to the health carrier's position;
(4) A reference to the evidence or documentation used as the basis for the decision;
(5) If applicable, a statement indicating:
(a) A description of the process to obtain an additional review of the standard review decision if the covered person wishes to request a voluntary second level review pursuant to § 58-17C-85; and
(b) The written procedures governing the voluntary review, including any required time frame for the review; and
(6) Notice of the covered person's right, at any time, to contact the Division of Insurance, including the telephone number and address of the Division of Insurance.

Source: SL 2003, ch 250, § 42.

State Codes and Statutes

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State Codes and Statutes

Statutes > South-dakota > Title-58 > Chapter-17c > Statute-58-17c-91

58-17C-91. Standard review--Required contents of written decision. The written decision issued pursuant to § 58-17C-90 shall contain:
(1) The titles and qualifying credentials of the person or persons participating in the standard review process (the reviewers);
(2) A statement of the reviewers' understanding of the covered person's grievance;
(3) The reviewers' decision in clear terms and the contract basis in sufficient detail for the covered person to respond further to the health carrier's position;
(4) A reference to the evidence or documentation used as the basis for the decision;
(5) If applicable, a statement indicating:
(a) A description of the process to obtain an additional review of the standard review decision if the covered person wishes to request a voluntary second level review pursuant to § 58-17C-85; and
(b) The written procedures governing the voluntary review, including any required time frame for the review; and
(6) Notice of the covered person's right, at any time, to contact the Division of Insurance, including the telephone number and address of the Division of Insurance.

Source: SL 2003, ch 250, § 42.