Learn About The Law
Get help with your legal needs
FindLaw’s Learn About the Law features thousands of informational articles to help you understand your options. And if you’re ready to hire an attorney, find one in your area who can help.
Current as of March 28, 2024 | Updated by Findlaw Staff
A private review agent or utilization review entity shall ensure that all appeals are reviewed by an appropriate healthcare provider who shall:
(1) Possess a current and valid nonrestricted license or maintain other appropriate legal authorization;
(2) Be currently in active practice in the same or similar specialty and who typically manages the medical condition or disease;
(3) Be knowledgeable of, and have experience providing, the healthcare service under appeal;
(4) Not have been directly involved in making the adverse determination; and
(5) Consider all known clinical aspects of the healthcare service under review, including, but not limited to, a review of all pertinent medical or other records provided to the private review agent or utilization review entity by the covered person's healthcare provider, any relevant records provided to such agent or entity by a facility, and any medical or other literature provided to such agent or entity by the healthcare provider.
Cite this article: FindLaw.com - Georgia Code Title 33. Insurance § 33-46-22 - last updated March 28, 2024 | https://codes.findlaw.com/ga/title-33-insurance/ga-code-sect-33-46-22/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
A free source of state and federal court opinions, state laws, and the United States Code. For more information about the legal concepts addressed by these cases and statutes, visit FindLaw’s Learn About the Law.
Get help with your legal needs
FindLaw’s Learn About the Law features thousands of informational articles to help you understand your options. And if you’re ready to hire an attorney, find one in your area who can help.
Search our directory by legal issue
Enter information in one or both fields (Required)