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Code · South Dakota · Title 58 · Chapter 58-17

58-17H-17. Utilization review program to use documented clinical review criteria--Criteria to be available to authorized agencies upon request.

73 words·~1 min read·/sd/title-58/chapter-58-17/58-17h-17·

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A utilization review program shall use documented clinical review criteria that are based on sound clinical evidence and are evaluated periodically to assure ongoing efficacy. A health carrier may develop its own clinical review criteria, or it may purchase or license clinical review criteria from qualified vendors. A health carrier shall make available its clinical review criteria upon request to authorized government agencies including the Division of Insurance and the Department of Health.
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