§ 62m-18

62M.18 ANNUAL POSTING ON WEBSITE; PRIOR AUTHORIZATIONS. (a) By April 1, 2022, and each April 1 thereafter, a health plan company must post on the health plan company's public website the following data for the immediately preceding calendar year for each commercial product: (1) the number of prior authorization requests for which an authorization was issued; (2) the number of prior authorization requests for which an adverse determination was issued and sorted by: (i) health care service; (ii) whether the adverse determination was appealed; and (iii) whether the adverse determination was upheld or reversed on appeal; (3) the number of prior authorization requests that were submitted electronically and not by facsimile or email or other method pursuant to section 62J.497; and (4) the reasons for prior authorization denial including but not limited to: (i) patient did not meet prior authorization criteria; (ii) incomplete information submitted by the provider to the utilization review organization; (iii) change in treatment program; and (iv) the patient is no longer covered by the plan. (b) All information posted under this section must be written in easily understandable language.

rganization; (iii) change in treatment program; and (iv) the patient is no longer covered by the plan. (b) All information posted under this section must be written in easily understandable language. History: 2020 c 114 art 1 s 20