Section 58-17C-99 - Expedited review for adverse determinations involving urgent carerequests--Appointment of peers for review. - South-dakota Statutes

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58-17C-99. Expedited review for adverse determinations involving urgent care requests--Appointment of peers for review. A health carrier shall establish written procedures for the expedited review of urgent care requests of grievances involving an adverse determination. In addition, a health carrier shall provide expedited review of a grievance involving an adverse determination with respect to concurrent review urgent care requests involving an admission, availability of care, continued stay, or health care service for a covered person who has received emergency services, but has not been discharged from a facility. The procedures shall allow a covered person or the covered person's authorized representative to request an expedited review under this section orally or in writing.
A health carrier shall appoint an appropriate clinical peer or peers in the same or similar specialty as would typically manage the case being reviewed to review the adverse determination. The clinical peer or peers may not have been involved in making the initial adverse determination.

Source: SL 2003, ch 250, § 50.

State Codes and Statutes

Statutes > South-dakota > Title-58 > Chapter-17c > Statute-58-17c-99

58-17C-99. Expedited review for adverse determinations involving urgent care requests--Appointment of peers for review. A health carrier shall establish written procedures for the expedited review of urgent care requests of grievances involving an adverse determination. In addition, a health carrier shall provide expedited review of a grievance involving an adverse determination with respect to concurrent review urgent care requests involving an admission, availability of care, continued stay, or health care service for a covered person who has received emergency services, but has not been discharged from a facility. The procedures shall allow a covered person or the covered person's authorized representative to request an expedited review under this section orally or in writing.
A health carrier shall appoint an appropriate clinical peer or peers in the same or similar specialty as would typically manage the case being reviewed to review the adverse determination. The clinical peer or peers may not have been involved in making the initial adverse determination.

Source: SL 2003, ch 250, § 50.

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State Codes and Statutes

Statutes > South-dakota > Title-58 > Chapter-17c > Statute-58-17c-99

58-17C-99. Expedited review for adverse determinations involving urgent care requests--Appointment of peers for review. A health carrier shall establish written procedures for the expedited review of urgent care requests of grievances involving an adverse determination. In addition, a health carrier shall provide expedited review of a grievance involving an adverse determination with respect to concurrent review urgent care requests involving an admission, availability of care, continued stay, or health care service for a covered person who has received emergency services, but has not been discharged from a facility. The procedures shall allow a covered person or the covered person's authorized representative to request an expedited review under this section orally or in writing.
A health carrier shall appoint an appropriate clinical peer or peers in the same or similar specialty as would typically manage the case being reviewed to review the adverse determination. The clinical peer or peers may not have been involved in making the initial adverse determination.

Source: SL 2003, ch 250, § 50.