§ 26.1-36.12-05 — Prior authorization - Nonurgent circumstances

North Dakota § 26.1-36.12-05

• Jurisdiction: North Dakota
• Title 26.1: Insurance
• Ch. 26.1-36.12: Prior Authorization for Health Insurance

Text

1. If a prior authorization review organization requires prior authorization of a health care
service, the prior authorization review organization shall make a prior authorization or
adverse determination and notify the enrollee and the enrollee's health care provider of
the decision within seven calendar days of obtaining all necessary information to make
the decision. For purposes of this section, "necessary information" includes the results
of any face-to-face clinical evaluation or second opinion that may be required.
2. A prior authorization review organization shall have written procedures to address the
failure of a health care provider or enrollee to provide the necessary information to
make a determination on the request. If the health care provider or enrollee fails to
provide the necessary information to the prior authorization review organization within
fourteen calendar days of a written request for all necessary information, the prior
authorization review organization may make an adverse determination.
3. A prior authorization review organization shall allow an enrollee and the enrollee's
health care provider at least fourteen business days to request an updated prior
authorization following an unforeseen change in the circumstances or care needs for
the enrollee following a nonurgent circumstance or provision of health care services for
the enrollee.