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2017 Mississippi Code
Title 41 - Public Health
Chapter 83 - Utilization Review of Availability of Hospital Resources and Medical Services
§ 41-83-1. Definitions
Universal Citation: MS Code § 41-83-1 (2017)
- As used in this chapter, the following terms shall be defined as follows:
- (a) "Utilization review" means a system for reviewing the appropriate and efficient allocation of hospital resources and medical services given or proposed to be given to a patient or group of patients as to necessity for the purpose of determining whether such service should be covered or provided by an insurer, plan or other entity.
- (b) "Private review agent" means a nonhospital-affiliated person or entity performing utilization review on behalf of:
- (i) An employer or employees in the State of Mississippi; or
- (ii) A third party that provides or administers hospital and medical benefits to citizens of this state, including: a health maintenance organization issued a certificate of authority under and by virtue of the laws of the State of Mississippi; or a health insurer, nonprofit health service plan, health insurance service organization, or preferred provider organization or other entity offering health insurance policies, contracts or benefits in this state.
- (c) "Utilization review plan" means a description of the utilization review procedures of a private review agent.
- (d) "Department" means the Mississippi State Department of Health.
- (e) "Certificate" means a certificate of registration granted by the Mississippi State Department of Health to a private review agent.
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