Article 1. General Provisions

Sec 20-2501. Definitions; scope

Sec 20-2502. Utilization review activities; exemptions

Sec 20-2503. Utilization review standards; applicability; definition

Sec 20-2504. Utilization review agents; certification; rules

Sec 20-2505. Application for certification

Sec 20-2506. Certification; responsibilities of department; cost recovery

Sec 20-2507. Certificates; renewal

Sec 20-2508. Denial, suspension or revocation of certificates; hearing; civil penalties

Sec 20-2509. Confidentiality

Sec 20-2510. Health care insurers requirements; medical directors

Sec 20-2511. Violation; injunctive relief

Article 2. Health Care Appeals

Sec 20-2530. Definitions

Sec 20-2531. Applicability; requirements

Sec 20-2532. Utilization review standards and criteria; requirements

Sec 20-2533. Denial; levels of review; disclosure; additional time after service by mail; review process

Sec 20-2534. Expedited medical review; expedited appeal

Sec 20-2535. Informal reconsideration

Sec 20-2536. Formal appeal

Sec 20-2537. External independent review; expedited external independent review

Sec 20-2538. Independent review organizations

Sec 20-2539. Rules

Sec 20-2540. Health care appeals fund

Sec 20-2541. Health care insurer fee