Nebraska Revised Statutes Chapter 44. Insurance § 44-5441. Prior authorization; period of validity

(2)(a) If a prior authorization is required for inpatient care at a general acute hospital, the prior authorization shall remain valid for the length of stay approved by the utilization review agent.

(b) If the health care provider submits a timely request for the continuation of inpatient care, the utilization review agent shall respond to this request prior to the expiration of the current authorization for inpatient care.

(c) If a utilization review agent fails to respond to a timely request for the continuation of inpatient care prior to the termination of the previously approved length of stay, then the health carrier shall continue to compensate the health care provider at the contracted rate for inpatient care provided until the utilization review agent issues its determination on the prior authorization request.

(d) Nothing in this subsection shall be interpreted to prohibit a health care provider or enrollee from appealing an adverse determination as allowed under state law. If an adverse determination is overturned on appeal, and no other legal action related to the claim is pending, then the health carrier shall reimburse the health care provider at the contracted rate for inpatient care provided to the enrollee.