As used in this part:
(1)"Additional business day" means the first weekday not designated as a state or federal holiday;
(2)"Adverse determination" has the same meaning as defined in § 56-61-102 ;
(3)"Chronic condition" means a condition that has an expected duration of one (1) year or more and requires ongoing medical attention or limits activities of daily living, or both;
(4)"Commissioner" has the same meaning as defined in § 56-1-102 ;
(5)"Emergency healthcare services" means emergency services as defined in § 56-7-2355 ;
(6)"Enrollee" has the same meaning as defined in § 56-6-703 ;
(7)"Enrollee benefit plan" means the right to have a payment made by a health carrier for a prescription drug listed on the applicable formulary or healthcare services in accordance with coverage con
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As used in this part: (1) "Additional business day" means the first weekday not designated as a state or federal holiday; (2) "Adverse determination" has the same meaning as defined in § 56-61-102 ; (3) "Chronic condition" means a condition that has an expected duration of one (1) year or more and requires ongoing medical attention or limits activities of daily living, or both; (4) "Commissioner" has the same meaning as defined in § 56-1-102 ; (5) "Emergency healthcare services" means emergency services as defined in § 56-7-2355 ; (6) "Enrollee" has the same meaning as defined in § 56-6-703 ; (7) "Enrollee benefit plan" means the right to have a payment made by a health carrier for a prescription drug listed on the applicable formulary or healthcare services in accordance with coverage contained within a health benefit plan delivered, issued for delivery, or renewed in this state; (8) "Facility" means an institution licensed under title 33 or 68; (9) "Health carrier" has the same meaning as defined in § 56-61-102 ; (10) "Healthcare prescriber" means a prescriber as defined in § 53-10-203 ; (11) "Healthcare professional" has the same meaning as defined in § 56-61-102 ; (12) "Healthcare provider" has the same meaning as defined in § 56-61-102 ; (13) "Healthcare service" means a service rendered by a healthcare provider or at a practice that provides testing, monitoring, diagnosis, or treatment of a human disease or condition, or dispenses medical devices, medical appliances, or medical goods for the treatment of a human disease or condition; (14) "Inpatient service" means care provided in a hospital or other type of inpatient facility where an individual is admitted and spends one (1) or more nights, depending on the individual's medical condition; (15) "Medically necessary" or "medical necessity" has the same meaning as defined in § 56-61-102 ; (16) "Physician" means a medical doctor or osteopathic physician with a valid state medical license issued pursuant to title 63, chapter 6 or 9; (17) "Practice" means an entity formed with at least one (1) healthcare provider to provide healthcare services; (18) "Prescription drug" has the same meaning as defined in § 56-7-3201 ; (19) "Prior authorization" means a written or oral determination made by a health carrier or utilization review organization, or an agent of such carrier or organization, that an enrollee's receipt of a healthcare service is a covered benefit under the applicable plan and that a requirement of medical necessity or other requirements imposed by such utilization review organization as prerequisites for payment for such services have been satisfied; (20) "Urgent care request" has the same meaning as defined in § 56-61-102 ; and (21) "Utilization review organization" means: (A) A health carrier or other entity, including a designee of such carrier or entity, that reviews or issues prior authorizations for a health carrier; and (B) A health maintenance organization, or another individual or entity that provides, offers to provide, or administers hospital, outpatient, medical, behavioral health, prescription drug, or other health benefits to a person treated by a healthcare provider in this state under a health insurance policy, plan, or contract.