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Current as of January 01, 2024 | Updated by Findlaw Staff
A health insuring corporation that conducts utilization review shall prepare a written utilization review program that describes all review activities, both delegated and nondelegated, for covered health care services provided, including the following:
(A) Procedures to evaluate the clinical necessity, appropriateness, efficacy, or efficiency of health care services;
(B) The use of data sources and clinical review criteria in making decisions;
(C) Mechanisms to ensure consistent application of criteria and compatible decisions;
(D) Data collection processes and analytical methods used in assessing utilization of health care services;
(E) Mechanisms for assuring confidentiality of clinical and proprietary information;
(F) The periodic assessment of utilization review activities, and the reporting of these assessments to the health insuring corporation's board, by a utilization review committee, a quality assurance committee, or any similar committee;
(G) The functional responsibility for day-to-day program management by staff;
(H) Defined methods by which guidelines are approved and communicated to providers and health care facilities.
Cite this article: FindLaw.com - Ohio Revised Code Title XVII. Corporations Partnerships § 1751.79 - last updated January 01, 2024 | https://codes.findlaw.com/oh/title-xvii-corporations-partnerships/oh-rev-code-sect-1751-79/
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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