33-32-105. Application -- exemptions. (1) Except as provided in subsections (2) and (3), the provisions of this chapter apply to:
(a) a health insurance issuer that offers a health plan and provides or performs utilization review services;
(b) any designee of the health insurance issuer or utilization review organization that performs utilization review functions on the health insurance issuer's behalf; and
(c) a health insurance issuer or its designated utilization review organization that provides or performs prospective review or retrospective review benefit determinations.
(2) A general in-house utilization review for a health care provider, including an in-house utilization review that is conducted by or for a long-term care facility and that is required by regulations for medicare or medicaid, is exempt from the provisions of this chapter as long as the review does not directly result in the approval or denial of payment for health care services for a particular case.
(3) A peer review procedure conducted by a professional society or association of providers is exempt from the provisions of this chapter.
History: En. Sec. 9, Ch. 665, L. 1991; amd. Sec. 38, Ch. 428, L. 2015.
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