Montana Code 33-32-206. Responsibility for contracted services
33-32-206. Responsibility for contracted services. Whenever a health insurance issuer contracts with a utilization review organization or other entity to perform the utilization review functions required by this part or rules adopted pursuant to this part, the commissioner shall hold the health insurance issuer responsible for monitoring the activities of the utilization review organization or the entity with which the health insurance issuer has contracted and for ensuring that the requirements of this part are met.
Terms Used In Montana Code 33-32-206
- Health insurance issuer: has the meaning provided in 33-22-140. See Montana Code 33-32-102
- Utilization review: means a set of formal techniques designed to monitor the use of or to evaluate the clinical necessity, appropriateness, efficacy, or efficiency of health care services, procedures, or settings. See Montana Code 33-32-102
- Utilization review organization: means an entity that conducts utilization review for one or more of the following:
(a)an employer with employees who are covered under a health benefit plan or health insurance policy;
(b)a health insurance issuer providing review for its own health plans or for the health plans of another health insurance issuer;
(c)a preferred provider organization or health maintenance organization; and
(d)any other individual or entity that provides, offers to provide, or administers hospital, outpatient, medical, or other health benefits to a person treated by a health care provider under a policy, plan, or contract. See Montana Code 33-32-102