Minnesota Administrative Rules
Agency 196 - Human Services Department
Chapter 9505 - HEALTH CARE PROGRAMS
CONDITIONS FOR MEDICAL ASSISTANCE AND GENERAL ASSISTANCE MEDICAL CARE PAYMENT
Part 9505.5077 - DETERMINATION BY PHYSICIAN ADVISER

Subpart 1. Physician adviser opinion.

Upon the request of an admitting physician or the medical review agent according to part 9505.5076, subpart 3, a physician adviser shall determine if a surgical procedure requiring a second medical opinion is medically appropriate. If the physician adviser determines that the surgical procedure requiring a second opinion is medically appropriate, the medical review agent shall issue an authorization number and notify the admitting physician and the recipient of the determination. If the physician adviser determines that the surgical procedure requiring a second opinion is not medically appropriate, the medical review agent shall deny an authorization number and notify the admitting physician and the recipient according to part 9505.5082. If the physician adviser is unable to determine if the surgical procedure is medically appropriate, the medical review agent shall notify the admitting physician by telephone, and the admitting physician may request a second physician adviser's opinion. If the admitting physician does not request a second physician adviser's opinion, the medical review agent shall deny the authorization number and shall notify the admitting physician and the recipient of the denial according to part 9505.5082.

Subp. 2. Second physician adviser's opinion.

If the admitting physician requests a second physician adviser's opinion under subpart 1, the medical review agent shall contact a second physician adviser. If the second physician adviser determines that the surgical procedure requiring a second medical opinion is medically appropriate, the medical review agent shall issue an authorization number. If the second physician adviser is unable to determine if the surgical procedure is medically appropriate, or determines that the procedure is not medically appropriate, the medical review agent shall deny an authorization number and notify the recipient and the admitting physician of the denial under part 9505.5082.