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Current as of January 01, 2024 | Updated by Findlaw Staff
1. A prior authorization review organization shall report to the insurance commissioner by September first of each year information regarding prior authorization requests for the previous calendar year.
2. The report must be available online and in a form specified by the commissioner.
3. The report must include the:
a. Total number of prior authorization requests received;
b. Number of prior authorization requests for which an authorization was issued;
c. Number of prior authorization requests for which an adverse determination was issued;
d. Number of adverse determinations reversed on appeal;
e. Reasons an adverse determination was issued, expressed as a percentage of all adverse determinations, which must include:
(1) The patient did not meet prior authorization criteria;
(2) Incomplete information was submitted by the provider to the prior authorization review organization;
(3) The treatment program changed; or
(4) The patient is no longer covered by the health benefit plan;
f. Number of prior authorization requests submitted but not necessary;
g. Number of prior authorization requests submitted by electronic means; and
h. Number of prior authorization requests submitted by nonelectronic means, including mail and facsimile.
Cite this article: FindLaw.com - North Dakota Century Code Title 26.1. Insurance § 26.1-36.12-17. Annual report to insurance commissioner - last updated January 01, 2024 | https://codes.findlaw.com/nd/title-26-1-insurance/nd-cent-code-sect-26-1-36-12-17/
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.
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