Montana Code 33-32-205. Corporate oversight of utilization review program
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33-32-205. Corporate oversight of utilization review program. A health insurance issuer is responsible for:
Terms Used In Montana Code 33-32-205
- Health insurance issuer: has the meaning provided in 33-22-140. See Montana Code 33-32-102
- Oversight: Committee review of the activities of a Federal agency or program.
- Utilization review: means a set of formal techniques designed to monitor the use of or to evaluate the clinical necessity, appropriateness, efficacy, or efficiency of health care services, procedures, or settings. See Montana Code 33-32-102
(1)monitoring all utilization review activities carried out by or on behalf of the health insurance issuer;
(2)ensuring that all requirements of this part and rules adopted pursuant to this part are met; and
(3)ensuring that appropriate personnel have operational responsibility for the conduct of the health insurance issuer’s utilization review program.