376.1372. Certification and member handbook to include utilization review procedures. - Missouri Statutes

Certification and member handbook to include utilization reviewprocedures.

376.1372. 1. In the certificate of coverage and the member handbookprovided to enrollees, a health carrier shall include a clear andcomprehensive description of its utilization review procedures, includingthe procedures for obtaining review of adverse determinations, and astatement of rights and responsibilities of enrollees with respect to thoseprocedures.

2. A health carrier shall include a summary of its utilization reviewprocedures in material intended for prospective enrollees.

3. A health carrier shall print on its membership cards a toll-freetelephone number to call for utilization review decisions.

(L. 1997 H.B. 335)