Chapter 62M — Minnesota Utilization Review Act of 1992

62M.01 Citation, Jurisdiction, and Scope This law is called the Minnesota Utilization Review Act of 1992. It applies to all health insurance companies, HMOs, and … 62M.02 Definitions This section defines important terms used in the Utilization Review Act. Key terms include 'adverse determination' (when … 62M.03 Compliance With Standards Any organization that reviews whether medical care is necessary must be licensed in Minnesota or registered with the … 62M.04 Standards for Utilization Review Performance This section sets rules for how utilization review must be done. Health plans must clearly explain the authorization … 62M.05 Procedures for Review Determination This section sets time limits for review decisions. Standard review decisions must be made within five business days. … 62M.06 Appeals of Adverse Determinations When your insurance denies a medical service, you and your doctor have the right to appeal. There are two types of … 62M.07 Prior Authorization of Services This section sets rules for prior authorization of medical services. Insurance companies cannot require prior … 62M.072 Use of Evidence-based Standards Establishes requirements for utilization review of step therapy protocols used by health plan companies. 62M.08 Confidentiality Utilization review organizations must keep patient information confidential. They must have written rules to protect … 62M.09 Staff and Program Qualifications This section requires that people who review medical care decisions must be properly trained and licensed. A doctor must … 62M.10 Accessibility and On-site Review Procedures Utilization review organizations must be easy to reach by toll-free phone during business hours and have a system for … 62M.11 Complaints to Commerce or Health If your insurance denies a medical service, you can file a complaint directly with the state commissioner who regulates … 62M.12 Prohibition of Inappropriate Incentives People who review medical claims cannot be paid bonuses or incentives based on how many claims they deny. Review … 62M.13 Severability If a court finds that one part of this chapter is invalid or unenforceable, the rest of the chapter still applies. This … 62M.14 Effect of Compliance Whether a utilization review organization followed or broke the rules in this chapter does not automatically decide a … 62M.15 Applicability of Other Chapter Requirements The rules in this chapter about utilization review are in addition to requirements in other Minnesota insurance laws. … 62M.16 Rulemaking If the state decides that additional rules are needed to carry out this chapter, those rules must be created jointly by … 62M.17 Continuity of Care; Prior Authorizations When you switch health plans, your new plan must honor prior authorizations from your old plan for at least 60 days. If … 62M.18 Annual Posting on Website; Prior Authorizations Provides additional provisions for utilization review of behavioral health services. 62M.19 Annual Report to Commissioner of Health; Prior Authorizations Contains provisions related to utilization review transparency and reporting requirements.