§ 36-6555. Rules - Forms - Issuance of certificate - Reporting requirements - Confidentiality.

A.  The Insurance Commissioner may promulgate and adopt rules to implement the provisions of this section.

B.  The Commissioner shall develop standardized forms for registration, performing and implementing certification requirements pursuant to the Hospital and Medical Services Utilization Review Act.

C.  The Commissioner shall issue a certificate to an applicant that has met all the requirements of the Hospital and Medical Services Utilization Review Act and applicable rules.

D.  The Commissioner may establish reporting requirements to:

1.  Evaluate, based upon the information furnished pursuant to the provisions of this act, the effectiveness of private review agents; and

2.  Determine if the utilization review programs are in compliance with the provisions of the Hospital and Medical Services Utilization Review Act and applicable rules.

E.  Any information required by the Commissioner with respect to customers, patients or utilization review procedures of a private review agent shall be held in confidence and shall not be disclosed to the public.  However, a patient or a person with financial responsibility for a patient's bill shall be entitled to information and documents relating to them and their claim.

F.  A certificate issued pursuant to the Hospital and Medical Services Utilization Review Act is not transferable.

G.  No individual conducting utilization review shall be required to be certified if such utilization review is performed within the scope of such person's employment with an entity already certified pursuant to the Hospital and Medical Services Review Act.

Added by Laws 1991, c. 294, § 5, eff. Nov. 1, 1991.