20-2503. Utilization review standards; applicability; definition
A. The utilization review standards established in this chapter apply to prospective, concurrent and retrospective utilization review for:
1. Inpatient admissions to hospitals and other inpatient facilities.
2. Outpatient admissions to surgical facilities.
3. Outpatient surgical services provided in a health care provider's office.
4. Medical, surgical and health care services that may be covered by a health care insurer depending on determinable contingencies, including without limitation outpatient services, in-office consultations with medical specialists, specialized diagnostic testing, mental health services, emergency care and inpatient and outpatient hospital services.
B. For purposes of this section " inpatient admissions" includes inpatient admissions to all acute medical, surgical, obstetrical, psychiatric and chemical dependency inpatient services at a licensed hospital or other inpatient facility.
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