Section 26-55-105 - Consultation After Issuing an Adverse Determination

26-55-105. Consultation after issuing an adverse determination. After issuing an adverse determination, the health insurer or contracted utilization review entity shall provide the opportunity to the health care provider to discuss the medical necessity of the health care service with the person who has decision making authority and will be responsible for determining authorization of the health care service under review. The health insurer or contract utilization review entity shall attempt to schedule the discussion within five (5) business days after the health care provider's request.