North Dakota § 26.1-36.12-03 Personnel qualified to make adverse determinations

North Dakota Statutes

§ 26.1-36.12-03 — Personnel qualified to make adverse determinations

North Dakota § 26.1-36.12-03

Title 26.1Insurance

Ch. 26.1-36.12Prior Authorization for Health Insurance

This text of North Dakota § 26.1-36.12-03 (Personnel qualified to make adverse determinations) is published on Counsel Stack Legal Research, covering North Dakota primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

N.D. Cent. Code § 26.1-36.12-03 (2026).

Text

A prior authorization review organization shall ensure all adverse determinations are made by a licensed physician or licensed pharmacist. The reviewing individual:

1.Must have experience treating patients with the condition or illness for which the health care service is being requested; and

2.Shall make the adverse determination under the clinical direction of one of the prior authorization review organization's medical directors who is responsible for the health care services provided to enrollees.

Free access — add to your briefcase to read the full text and ask questions with AI

A prior authorization review organization shall ensure all adverse determinations are made
by a licensed physician or licensed pharmacist. The reviewing individual:
1. Must have experience treating patients with the condition or illness for which the health
care service is being requested; and
2. Shall make the adverse determination under the clinical direction of one of the prior
authorization review organization's medical directors who is responsible for the health
care services provided to enrollees.