§ 26.1-36.12-17 — Annual report to insurance commissioner

North Dakota § 26.1-36.12-17

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

Text

1. A prior authorization review organization shall report to the insurance commissioner by
September first of each year information regarding prior authorization requests for the
previous calendar year.
2. The report must be available online and in a form specified by the commissioner.
3. The report must include the:
a. Total number of prior authorization requests received;
b. Number of prior authorization requests for which an authorization was issued;
c. Number of prior authorization requests for which an adverse determination was
issued;
d. Number of adverse determinations reversed on appeal;
e. Reasons an adverse determination was issued, expressed as a percentage of all
adverse determinations, which must include:
(1) The patient did not meet prior authorization criteria;
(2) Incomplete information was submitted by the provider to the prior
authorization review organization;
(3) The treatment program changed; or
(4) The patient is no longer covered by the health benefit plan;
f. Number of prior authorization requests submitted but not necessary;
g. Number of prior authorization requests submitted by electronic means; and
h. Number of prior authorization requests submitted by nonelectronic means,
including mail and facsimile.