33-32-102. Definitions. - Montana Statutes

     33-32-102. Definitions. As used in this chapter, the following definitions apply:
     (1) "Commissioner" means the commissioner of insurance provided for in 2-15-1903.
     (2) "Health care provider" means a person, corporation, facility, or institution licensed by the state to provide or otherwise lawfully providing health care services, including but not limited to:
     (a) a physician, health care facility as defined in 50-5-101, osteopath, dentist, nurse, optometrist, chiropractor, podiatrist, physical therapist, psychologist, licensed social worker, speech pathologist, audiologist, licensed addiction counselor, or licensed professional counselor; and
     (b) an officer, employee, or agent of a person described in subsection (2)(a) acting in the course and scope of employment.
     (3) "Health care services" means the health care and services provided by health care providers, including drugs, medicines, ambulance services, and other therapeutic and rehabilitative services and supplies.
     (4) (a) "Utilization review" means a system for review of health care services for a patient to determine the necessity or appropriateness of services, whether that review is prospective, concurrent, or retrospective, when the review will be used directly or indirectly in order to determine whether the health care services will be paid, covered, or provided.
     (b) Utilization review does not include routine claim administration or determination that does not include determinations of medical necessity or appropriateness.

     History: En. Sec. 2, Ch. 665, L. 1991; amd. Sec. 3, Ch. 23, L. 2001.