Rhode Island General Laws 27-18.9-9. Reporting requirements
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The office shall establish reporting requirements to determine if adverse benefit determination and/or utilization review programs are in compliance with the provisions of this chapter and applicable regulations as well as in compliance with applicable federal law.
History of Section.
P.L. 2017, ch. 302, art. 5, § 5.
Terms Used In Rhode Island General Laws 27-18.9-9
- Adverse benefit determination: means a decision not to authorize a healthcare service, including a denial, reduction, or termination of, or a failure to provide or make a payment, in whole or in part, for a benefit. See Rhode Island General Laws 27-18.9-2
- Office: means the office of the health insurance commissioner. See Rhode Island General Laws 27-18.9-2
- Utilization review: means the prospective, concurrent, or retrospective assessment of the medical necessity and/or appropriateness of the allocation of healthcare services of a provider, given or proposed to be given, to a beneficiary. See Rhode Island General Laws 27-18.9-2