2014 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 32 - Nonprofit Hospital, Medical-Surgical, Dental and Health Service Corporations 32.32-147 Requirements for health service corporation that issues policy or administers program providing for utilization review of benefits.
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304.32-147 Requirements for health service corporation that issues policy or
administers program providing for utilization review of benefits.
(1)
(2)
Every nonprofit hospital, medical-surgical, dental, and health service
corporation proposing to issue or deliver in this state a health insurance policy
or contract or administer a health benefit program which provides for the
coverage of hospital benefits and the utilization review of those benefits by a
private review agent shall:
(a) Be a registered private review agent in accordance with KRS
304.17A-607 and administrative regulations promulgated under the
authority of KRS 304.17A-613; or
(b) Contract with a private review agent that has been registered in
accordance with KRS 304.17A-607 and administrative regulations
promulgated under the authority of KRS 304.17A-613.
Notwithstanding any other provision of KRS 304.17A-603, 304.17A-605,
304.17A-607, 304.17A-609, 304.17A-611, 304.17A-613, and 304.17A-615, a
nonprofit hospital, medical-surgical, dental, and health service corporation shall
not deny or reduce payment of health benefits to any person, licensed
practitioner, or health facility for covered services which have been rendered to
an insured unless:
(a) Notice of denial has been issued. The notice shall inform patients,
authorized persons, and health-care providers of their right to appeal
adverse determinations of a utilization review by the insurer, its designee,
or private review agent to the insurer for the internal appeal process
established by the insurer in accordance with KRS 304.17A-617 and
304.17A-619. The notice shall also include instructions on filing an appeal
to the cabinet; and
(b) The nonprofit hospital, medical-surgical, dental, and health service
corporation is in compliance with subsection (1) of this section.
Effective:July 14, 2000
History: Amended 2000 Ky. Acts ch. 262, sec. 29, effective July 14, 2000. -Amended 1998 Ky. Acts ch. 426, sec. 527, effective July 15, 1998. -- Amended
1996 Ky. Acts ch. 353, sec. 3, effective July 15, 1996. -- Created 1990 Ky. Acts
ch. 451, sec. 9, effective July 13, 1990.
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