Louisiana Administrative Code
Title 37 - INSURANCE
Part XIII - Regulations
Chapter 62 - Regulation Number 103-Utilization Review Organizations and Independent Review Organizations
Section XIII-6201 - Purpose
Universal Citation: LA Admin Code XIII-6201
Current through Register Vol. 50, No. 3, March 20, 2024
A. The purpose of this regulation is:
1. to establish the
standards and criteria for the structure and operation of utilization review
and benefit determination processes designed to facilitate ongoing assessment
and management of health care services;
2. to provide the standards for the
establishment and maintenance of procedures by health insurance issuers to
assure that covered persons have the opportunity for the appropriate resolution
of internal and external appeals; and
3. to provide uniform standards for the
establishment and maintenance of an internal claims and appeals process and
external review procedures to assure that covered persons have the opportunity
for an independent review of an adverse determination or final adverse
determination.
AUTHORITY NOTE: Promulgated in accordance with RS. 22:2452.
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