Section 27-3A-1 – Short Title.

Section 27-3A-1 Short title. This chapter may be cited as the “Health Care Service Utilization Review Act.” (Acts 1994, 1st Ex. Sess., No. 94-786, p. 80, §1.)

Section 27-3A-2 – Purposes.

Section 27-3A-2 Purposes. The purposes of this chapter are to: (1) Promote the delivery of quality health care in a cost-effective manner. (2) Assure that utilization review agents adhere to reasonable standards for conducting utilization review. (3) Foster greater coordination and cooperation between health care providers and utilization review agents. (4) Improve communications and knowledge […]

Section 27-3A-3 – Definitions.

Section 27-3A-3 Definitions. As used in this chapter, the following words and phrases shall have the following meanings: (1) DEPARTMENT. The Alabama Department of Public Health. (2) ENROLLEE. An individual who has contracted for or who participates in coverage under an insurance policy, a health maintenance organization contract, a health service corporation contract, an employee […]

Section 27-3A-4 – Duties of Utilization Review Agents.

Section 27-3A-4 Duties of utilization review agents. (a) Utilization review agents shall adhere to the minimum standards set forth in Section 27-3A-5. (b) On or after July 1, 1994, a utilization review agent shall not conduct a utilization review in this state unless the agent has certified to the department in writing that the agent […]

Section 27-3A-5 – Standards for Utilization Review Agents.

Section 27-3A-5 Standards for utilization review agents. (a) Except as provided in subsection (b), all utilization review agents shall meet the following minimum standards: (1) Notification of a determination by the utilization review agent shall be mailed or otherwise communicated to the provider of record or the enrollee or other appropriate individual within two business […]

Section 27-3A-6 – Violations of Chapter by Utilization Review Agent.

Section 27-3A-6 Violations of chapter by utilization review agent. (a) Whenever the department has reason to believe that a utilization review agent subject to this chapter has been or is engaged in conduct that violates this chapter, the department shall notify the utilization review agent of the alleged violation. The agent shall respond to the […]