§ 65-02-19 — Organization to contract for administrative services

Repealed by S.L. 1999, ch. 554, § 4.
65-02-20. Organization to establish managed care program.
The organization shall establish a managed care program, including utilization review and
bill review, to effect the best medical solution for an injured employee in a cost-effective manner
upon a finding by the organization that the employee suffered a compensable injury. The
program shall operate according to guidelines adopted by the organization and shall provide for
medical management of claims within the bounds of workforce safety and insurance law.
Information compiled and analysis performed pursuant to a managed care program which relate
to patterns of treatment, cost, or outcomes by health care providers and allied health care
professionals are confidential and are not open to public inspection to the extent the information
and analysis identify a specific health care provider or allied health care professional, except to
the specific health care provider, allied health care professional, organization employees, or
persons rendering assistance to the organization in the administration of this title. If an
employee, employer, or allied health care professional disputes a managed care decision, the
employee, employer, or allied health care professional shall request binding dispute resolution
on the decision. The organization shall make rules providing for the procedures for dispute
resolution. Dispute resolution under this section is not subject to chapter 28-32 or section
65-01-16. A dispute resolution decision under this section requested by an allied health care
professional concerning payment for medical treatment already provided or a request for
diagnostic tests or treatment is not reviewable by any court. A dispute resolution decision under
this section requested by an employee is reviewable by a court only if medical treatment has
been denied to the employee. A dispute resolution decision under this section requested by an
employer is reviewable by a court only if medical treatment is awarded to the employee. The

dispute resolution decision may be reversed only if the court finds an abuse of discretion in the
dispute resolution process. Any person providing binding dispute resolution services under this
section is exempt from civil liability relating to the binding dispute resolution process and
decision.