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2017 Mississippi Code
Title 41 - Public Health
Chapter 83 - Utilization Review of Availability of Hospital Resources and Medical Services
§ 41-83-25. Health insurance plans; certificate requirement; contract with private review agent; reimbursement under policy where medical necessity in dispute
Universal Citation: MS Code § 41-83-25 (2017)
- (1) Every health insurance plan proposing to issue or deliver a health insurance policy or contract or administer a health benefit program which provides for the coverage of hospital and medical benefits and the utilization review of those benefits shall:
- (a) Have a certificate in accordance with this chapter; or
- (b) Contract with a private review agent who has a certificate in accordance with this chapter.
- (2) Notwithstanding any other provisions of this chapter, for claims where the medical necessity of the provision of a covered benefit is disputed, a health service plan that does not meet the requirements of subsection (1) of this section shall pay any person or hospital entitled to reimbursement under the policy or contract.
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