Section 58-17C-83 - Review of adverse determinations--Time for filing--Designation andnotice of reviewers--Scope of review. - South Dakota Statutes

58-17C-83. Review of adverse determinations--Time for filing--Designation and notice of reviewers--Scope of review. Within one hundred eighty days after the date of receipt of a notice of an adverse determination sent pursuant to §§ 58-17C-1, 58-17C-27, 58-17C-28, 58-17C-30, 58-17C-37, 58-17C-40, 58-17C-40.1, 58-17C-46, 58-17C-48 to 58-17C-52, inclusive, 58-17C-54 and 58-17C-71 to 58-17C-79, inclusive, and to §§ 58-17C-35 to 58-17C-37, inclusive, a covered person or the covered person's authorized representative may file a grievance with the health carrier requesting a first level review of the adverse determination. The health carrier shall provide the covered person with the name, address, and telephone number of a person or organizational unit designated to coordinate the first level review on behalf of the health carrier. The health carrier shall designate a health care provider or providers who have appropriate training and experience in the field of medicine involved in the medical judgement to evaluate the adverse determination. No health care provider or providers may have been involved in the initial adverse determination. In conducting the review, the reviewer or reviewers shall take into consideration all comments, documents, records, and other information regarding the request for services submitted by the covered person or the covered person's authorized representative, without regard to whether the information was submitted or considered in making the initial adverse determination.

Source: SL 2003, ch 250, § 34.