South Dakota Administrative Rules
Title 20 - PUBLIC SAFETY
Article 20:06 - INSURANCE
Chapter 20:06:53 - External and internal review
Section 20:06:53:41 - Independent review organization clinical reviewer written opinion for experimental or investigational treatment reviews
Universal Citation: SD Admin Rules 20:06:53:41
Current through Register Vol. 50, page 114, March 25, 2024
In accordance with §§ 20:06:53:45 and 20:06:53:46, each clinical reviewer shall provide a written opinion to the assigned independent review organization on whether the recommended or requested health care service or treatment should be covered. In reaching an opinion, clinical reviewers are not bound by any decisions or conclusions reached during the health carrier's utilization review process as set forth in SDCL 58-17H-1 to 58-17H-49, inclusive.
General Authority: SDCL 58-17-87, 58-17H-49, 58-17I-16, 58-18-79.
Law Implemented: SDCL 58-17-87, 58-18-79.
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