Ohio § 1751.79 Utilization review program requirements

Ohio Statutes

§ 1751.79 — Utilization review program requirements

Ohio § 1751.79

Title 17Corporations-Partnerships

Ch. 1751Health Insuring Corporation Law

This text of Ohio § 1751.79 (Utilization review program requirements) is published on Counsel Stack Legal Research, covering Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ohio Rev. Code Ann. § 1751.79 (2026).

Text

A health insuring corporation that conducts utilization review shall prepare a written utilization review program that describes all review activities, both delegated and nondelegated, for covered health care services provided, including the following:

(A)Procedures to evaluate the clinical necessity, appropriateness, efficacy, or efficiency of health care services;

(B)The use of data sources and clinical review criteria in making decisions;

(C)Mechanisms to ensure consistent application of criteria and compatible decisions;

(D)Data collection processes and analytical methods used in assessing utilization of health care services;

(E)Mechanisms for assuring confidentiality of clinical and proprietary information;

(F)The periodic assessment of utilization review activities, and t

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A health insuring corporation that conducts utilization review shall prepare a written utilization review program that describes all review activities, both delegated and nondelegated, for covered health care services provided, including the following:

(A) Procedures to evaluate the clinical necessity, appropriateness, efficacy, or efficiency of health care services;

(B) The use of data sources and clinical review criteria in making decisions;

(C) Mechanisms to ensure consistent application of criteria and compatible decisions;

(D) Data collection processes and analytical methods used in assessing utilization of health care services;

(E) Mechanisms for assuring confidentiality of clinical and proprietary information;

(F) The periodic assessment of utilization review activities, and the reporting of these assessments to the health insuring corporation's board, by a utilization review committee, a quality assurance committee, or any similar committee;

(G) The functional responsibility for day-to-day program management by staff;

(H) Defined methods by which guidelines are approved and communicated to providers and health care facilities.