MyLRC +
Administrative Rules
Rule 67:16:41:15 Utilization review.

          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.

 

Online Archived History: