58-17H-31. Calculation of time period for determination for prospective and retrospective reviews.
215 words·~1 min read·
/sd/title-58/chapter-58-17/58-17h-31·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
For purposes of calculating the time periods within which a determination is required to be made for prospective and retrospective reviews, the time period within which the determination is required to be made begins on the date the request is received by the health carrier in accordance with the health carrier's procedures established pursuant to § 58-17H-16 . If the time period for making the determination for a prospective or retrospective review is extended due to the covered person or, if applicable, the covered person's authorized representative's failure to submit the information necessary to make the determination, the time period for making the determination shall be tolled from the date on which the health carrier sends the notification of the extension to the covered person or, if applicable, the covered person's authorized representative, until the earlier of: the date on which the covered person or, if applicable, the covered person's authorized representative, responds to the request for additional information or the date on which the specified information was to have been submitted.
If the covered person or the covered person's authorized representative fails to submit the information before the end of the period of the extension, as specified in §§ 58-17H-28 and 58-17H-30 , the health carrier may deny the certification of the requested benefit.