Sec. 35. Personnel qualified to make adverse determinations of a prior authorization request.
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/il/chapter-215/act-200/35A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Sec. 35. Personnel qualified to make adverse determinations of a prior authorization request. A health insurance issuer or its contracted utilization review organization must ensure that all adverse determinations are made by a physician when the request is by a physician or a representative of a physician. The physician must:
(1)possess a current and valid nonrestricted license in any United States
jurisdiction; and
(2)have experience treating and managing patients with the medical condition or
disease for which the health care service is being requested.
Notwithstanding the foregoing, a licensed health care professional who satisfies the requirements of this Section may make an adverse determination of a prior authorization request submitted by a health care professional licensed in the same profession.