§ 58-67-11. Additional HMO application information. - North Carolina Statutes

§58‑67‑11.  Additional HMO application information.

(a)        In addition to theinformation filed under G.S. 58‑67‑10(c), each application shallinclude a description of the following:

(1)        The program to beused to evaluate whether the applicant's provider network is sufficient, innumbers and types of providers, to assure that all health care services will beaccessible without unreasonable delay.

(2)        The program to beused for verifying provider credentials.

(3)        The qualitymanagement program to assure quality of care and health care services managedand provided through the health care plan.

(4)        The utilizationreview program for the review and control of health care services provided orpaid for.

(5)        The applicant'sprovider network and evidence of the ability of that network to provide allhealth care services to the applicant's prospective enrollees.

(b)        G.S. 58‑67‑10(d)applies to the information specified in this section. (1997‑519,s. 1.2.)