37.108.301    INDEPENDENT REVIEW OF HEALTH CARE DECISIONS: DEFINITIONS

The following definitions, in addition to those contained in 33-37-101 , MCA, apply to this chapter:

(1) "Expedited review" means an accelerated appeal of an adverse determination made by a health carrier or managed care entity involving an enrollee with urgent medical needs whose life or health would be seriously threatened by the delay of a standard appeals process.

(2) "Independent review organization" means a network of peers conducting an independent review of an adverse determination made by a health carrier or managed care entity.

(3) "Internal appeals process" means a process established by a health carrier or managed care entity by which a party affected by an adverse determination made by a health carrier or managed care entity may appeal the adverse decision within the deciding agency.

History: Sec. 33-37-105, MCA; IMP, Sec. 33-37-101 and 33-37-105, MCA; NEW, 1999 MAR p. 2880, Eff. 12/17/99; AMD, 2003 MAR p. 1662, Eff. 8/1/03.