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  • ARTICLE 49
    Utilization Review and External Appeal
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  • TITLE 2
    Right to External Appeal
    • This entry was published on 2023-09-08
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    TITLE 1

    Certification of Agents and Utilization Review Process

    Public Health (PBH) CHAPTER 45, ARTICLE 49

    TITLE I

    CERTIFICATION OF AGENTS AND UTILIZATION REVIEW PROCESS
    Section 4900. Definitions.

    4901. Registration of utilization review agents.

    4902. Utilization review program standards.

    4903. Utilization review determinations.

    4904. Appeal of adverse determinations by utilization review

    agents.

    4905. Required and prohibited practices.

    4906. Waiver.

    4907. Rights and remedies.

    4908. Applicability to ERISA Plans.

    4909. Site of service clinical review.