Maine Revised Statutes Title 24-A Sec. 2773 – Utilization review services
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As used in this chapter, unless the context indicates otherwise, “utilization review services” or “medical utilization review services” means a program or process by which a person, partnership or corporation, on behalf of an insurer, nonprofit service organization, 3rd-party administrator, health maintenance organization, preferred provider organization or employer that is a payor for or that arranges for payment of medical services, seeks to review the utilization, appropriateness or quality of medical services provided to a person whose medical services are paid for, partially or entirely, by that insurer, nonprofit service organization, 3rd-party administrator, health maintenance organization, preferred provider organization or employer. The terms include these programs or processes whether they apply prospectively or retrospectively to medical services. Utilization review services include, but are not limited to, the following: [PL 1993, c. 602, §7 (AMD).]
1. Second opinion programs. Second opinion programs;
[PL 1989, c. 556, Pt. C, §2 (NEW).]
Terms Used In Maine Revised Statutes Title 24-A Sec. 2773
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
2. Prehospital admission certification. Prehospital admission certification;
[PL 1989, c. 556, Pt. C, §2 (NEW).]
3. Preinpatient service eligibility certification. Preinpatient service eligibility certification; and
[PL 1989, c. 556, Pt. C, §2 (NEW).]
4. Concurrent hospital review. Concurrent hospital review to determine appropriate length of stay.
[PL 1989, c. 556, Pt. C, §2 (NEW).]
SECTION HISTORY
PL 1989, c. 556, §C2 (NEW). PL 1993, c. 602, §7 (AMD).