67:16:41:15. Utilization review. Utilization review may be conducted on the following levels:
(1) Computerized claim processing;
(2) Postpayment review; and
(3) Peer review.
A peer review entity appointed by the department shall review claims to determine and ensure the appropriate quality, quantity, and medical necessity of mental health services provided.
Source: 22 SDR 6, effective July 26, 1995.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.
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