§ 27-8-17-8 — "Utilization review determination" defined

(a) As used in this chapter, "utilization review
determination" means the rendering of a decision based on utilization
review that denies or affirms either of the following:
(1) The necessity or appropriateness of the allocation of
resources.
(2) The provision or proposed provision of health care services to
a covered individual.
(b) The term does not include the identification of alternative,
optional medical care that:
(1) requires the approval of the covered individual; and
(2) does not affect coverage or benefits if rejected by the covered
individual.

Legislative History

As added by P.L.128-1992, SEC.1.