Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.108 - MANAGED CARE QUALITY ASSURANCE
Subchapter 37.108.3 - Independent Review of Health Care Decisions
Rule 37.108.301 - INDEPENDENT REVIEW OF HEALTH CARE DECISIONS: DEFINITIONS
Current through Register Vol. 6, March 22, 2024
The following definitions, in addition to those contained in 33-37-101, MCA, apply to this chapter:
(1) "Expedited review" means an accelerated appeal of an adverse determination made by a health carrier or managed care entity involving an enrollee with urgent medical needs whose life or health would be seriously threatened by the delay of a standard appeals process.
(2) "Independent review organization" means a network of peers conducting an independent review of an adverse determination made by a health carrier or managed care entity.
(3) "Internal appeals process" means a process established by a health carrier or managed care entity by which a party affected by an adverse determination made by a health carrier or managed care entity may appeal the adverse decision within the deciding agency.
Sec. 33-37-105, MCA; IMP, Sec. 33-37-101 and 33-37-105, MCA;
