HEALTH CARE UTILIZATION REVIEW

Appeals

Consulting physicians, Minn. Statutes 2004 62M.06, 62M.09

Generally, Minn. Statutes 2004 62M.06

Prior authorization, denial, Minn. Statutes 2004 62M.07

Procedures, Minn. Statutes 2004 62M.06, 62M.07

Reporting requirements, Minn. Statutes 2004 62M.09

Application of law

Appeals procedures, Minn. Statutes 2004 62M.01, 62M.06

Certification denials, financial incentives, Minn. Statutes 2004 62M.12

Generally, Minn. Statutes 2004 62M.01, 62M.15

Outpatient mental health or substance abuse services, Minn. Statutes 2004 62M.09

Physician reviewers, licenses, Minn. Statutes 2004 62M.09

Unlicensed organizations, regulation of trade practices, Minn. Statutes 2004 62M.03

Attending health care professionals

Appeals, Minn. Statutes 2004 62M.06, 62M.07, 62M.09

Certification, see same under this topic

Clinical criteria, review, Minn. Statutes 2004 62M.09

Data, certification, Minn. Statutes 2004 62M.02

Defined, Minn. Statutes 2004 62M.02

Notice received, Minn. Statutes 2004 62M.04 to 62M.06, 62M.10

On-site reviews, Minn. Statutes 2004 62M.10

Certification

Appeals, Minn. Statutes 2004 62M.06

Audit trails, Minn. Statutes 2004 62M.05

Certification numbers, Minn. Statutes 2004 62M.05

Data, Minn. Statutes 2004 62M.04

Defined, Minn. Statutes 2004 62M.02

Denials

Appeals, Minn. Statutes 2004 62M.06

Application of law, Minn. Statutes 2004 62M.12

Attending physician, rights, Minn. Statutes 2004 62M.06

Complaints, enrollees' rights, Minn. Statutes 2004 62D.11, 62M.11

Criteria, Minn. Statutes 2004 62M.05

Financial incentives, Minn. Statutes 2004 62M.12

Grounds, Minn. Statutes 2004 62M.05

Lawsuits, compliance with regulations, effect, Minn. Statutes 2004 62M.14

Notice, Minn. Statutes 2004 62M.05

Review, Minn. Statutes 2004 62M.04

Determinations, notice, Minn. Statutes 2004 62M.05

Notice, Minn. Statutes 2004 62M.04, 62M.05

Outpatient services, Minn. Statutes 2004 62M.09

Providers' failure to supply information, procedures, Minn. Statutes 2004 62M.05

Review, Minn. Statutes 2004 62M.04, 62M.05

Claimants

Defined, Minn. Statutes 2004 62M.02

Notice received, certification, denial, Minn. Statutes 2004 62M.05

Claims administrators

Contracts, utilization review certification, Minn. Statutes 2004 62M.04

Defined, Minn. Statutes 2004 62M.02

Notice given, Minn. Statutes 2004 62M.05, 62M.06

Notice received, Minn. Statutes 2004 62M.05 to 62M.07

Prior authorization, Minn. Statutes 2004 62M.07

Clinical criteria

Defined, Minn. Statutes 2004 62M.02

Physicians, duties, Minn. Statutes 2004 62M.09

Concurrent review

Committed persons, rights, Minn. Statutes 2004 253B.03

Generally, Minn. Statutes 2004 62M.02 to 62M.05

Contested cases

Unlicensed organizations, cease and desist orders, Minn. Statutes 2004 62M.03

Continued stay review, Minn. Statutes 2004 62M.02 to 62M.05, 253B.03

County-based purchasing, Minn. Statutes 2004 256B.692

Data, Minn. Statutes 2004 62M.04, 62M.08

Definitions

Generally, Minn. Statutes 2004 62M.02

Information for review, Minn. Statutes 2004 62M.04

Review determination procedures, Minn. Statutes 2004 62M.05

Diagnostic imaging facilities, Minn. Statutes 2004 144.565

Employees

Financial incentives for denials, Minn. Statutes 2004 62M.12

Identification, Minn. Statutes 2004 62M.10

On-site reviews, Minn. Statutes 2004 62M.10

Utilization review organizations, Minn. Statutes 2004 62M.09

Enforcement of law

County-based purchasing, Minn. Statutes 2004 256B.692

Health Department, powers, Minn. Statutes 2004 256B.77

Enrollees

Appeals by, Minn. Statutes 2004 62M.06, 62M.07, 62M.09

Certification review organizations, data sharing, Minn. Statutes 2004 62M.04

Claimants, enrollees defined as, Minn. Statutes 2004 62M.02

Complaints, rights, Minn. Statutes 2004 62D.11, 62M.11

Data, certification, Minn. Statutes 2004 62M.04

Defined, Minn. Statutes 2004 62M.02

Notice given, Minn. Statutes 2004 62M.04, 62M.07

Notice received, Minn. Statutes 2004 62M.05 to 62M.07

On-site reviews, Minn. Statutes 2004 62M.10

Reports received, utilization review organizations, review criteria, Minn. Statutes 2004 62M.10

Unconscious persons, utilization review, Minn. Statutes 2004 62M.02

Fines, unlicensed organizations, Minn. Statutes 2004 62M.03

Health Care Utilization Act, Minn. Statutes 2004 62M.01 to 62M.16

Implementation, timetable, Minn. Statutes 2004 62J.017

Lawsuits, compliance with regulations, effect, Minn. Statutes 2004 62M.14

Licenses, utilization review organizations, Minn. Statutes 2004 62M.03

On-site reviews, Minn. Statutes 2004 62M.10

Orders, unlicensed utilization review organizations

Contested cases, Minn. Statutes 2004 62M.03

Patient services, exclusions, Minn. Statutes 2004 295.50

Prior authorization, Minn. Statutes 2004 62M.02, 62M.07

Procedures, health plan companies, notice, Minn. Statutes 2004 62Q.71

Prospective review, defined, Minn. Statutes 2004 62M.02

Providers

Agreements, review, procedures, Minn. Statutes 2004 62M.10

Appeals, duties, Minn. Statutes 2004 62M.06, 62M.07

Application of law, certification denial, inappropriate incentives, Minn. Statutes 2004 62M.12

Attending health care professionals, see same under this topic

Certification, see same under this topic

Claimants, providers defined as, Minn. Statutes 2004 62M.02

Contracts, utilization review certification, Minn. Statutes 2004 62M.04

Data, certification, Minn. Statutes 2004 62M.04

Defined, Minn. Statutes 2004 62M.02

Diagnoses, numeric codes, providing, Minn. Statutes 2004 62M.04

Disciplinary action, Minn. Statutes 2004 147.091

Essential community providers, Minn. Statutes 2004 62Q.19

Failure to provide information, procedures, Minn. Statutes 2004 62M.05

Notice given, health care utilization, certification requests, Minn. Statutes 2004 62M.04

Notice received, Minn. Statutes 2004 62M.05, 62M.07, 62M.10

On-site reviews, Minn. Statutes 2004 62M.10

Payments to, medical record duplication costs, reimbursements, Minn. Statutes 2004 62M.04

Prior authorization requests, Minn. Statutes 2004 62M.07

Referrals, Minn. Statutes 2004 62M.02

Reports received, utilization review organizations, review criteria, Minn. Statutes 2004 62M.10

Review by, certification, cases, Minn. Statutes 2004 62M.04

Quality assessment program, Minn. Statutes 2004 62M.02, 62M.09

Reconsideration requests, defined, Minn. Statutes 2004 62M.02

Review

Concurrent review, Minn. Statutes 2004 62M.02 to 62M.05, 253B.05

On-site review, Minn. Statutes 2004 62M.10

Rulemaking about, Minn. Statutes 2004 62M.16

Scope, Minn. Statutes 2004 62M.01

Severability of law, Minn. Statutes 2004 62M.13

Standards

Claims administrators, duties, Minn. Statutes 2004 62M.04

Compliance, Minn. Statutes 2004 62M.03

Information for review, Minn. Statutes 2004 62M.04

Insurance Fair Information Reporting Act, compliance, Minn. Statutes 2004 62M.04

Integrated children's mental health service system, Minn. Statutes 2004 245.494

Medical records, use, Minn. Statutes 2004 62M.04

Telephones, Minn. Statutes 2004 62M.10

Utilization review organizations

Accountability, delegated activities, clinics or health care systems, Minn. Statutes 2004 62M.02

Agreements, on-site reviews, procedures, Minn. Statutes 2004 62M.10

Annual reports, Minn. Statutes 2004 62M.09

Appeals, Minn. Statutes 2004 62M.06, 62M.07, 62M.09

Certificates and certification, defined, Minn. Statutes 2004 62M.02

Certification, see same under this topic

Clinical criteria, Minn. Statutes 2004 62M.02, 62M.09

Contracts, continuing care program, mentally ill persons, Minn. Statutes 2004 256.9693

Defined, Minn. Statutes 2004 62M.02

Delegation of duties, limitations, Minn. Statutes 2004 62M.02

Employees, Minn. Statutes 2004 62M.09

Licensed utilization review organizations, Minn. Statutes 2004 62M.03

Notice given, Minn. Statutes 2004 62M.03, 62M.05, 62M.06, 62M.07, 62M.09

Notice received, Minn. Statutes 2004 62M.04

Payments by, medical records, duplication costs, Minn. Statutes 2004 62M.04

Physician consultants, Minn. Statutes 2004 62M.09

Prior authorization, Minn. Statutes 2004 62M.07

Quality assessment program, Minn. Statutes 2004 62M.02, 62M.09

Reports given, Minn. Statutes 2004 62M.09, 62M.10

Requests, Minn. Statutes 2004 62M.04

Review procedures, Minn. Statutes 2004 62M.05, 62M.09, 62M.10

Standards, Minn. Statutes 2004 62M.03, 62M.04

Unlicensed utilization review organizations, Minn. Statutes 2004 62M.03

Violations and penalties

Disciplinary action, Minn. Statutes 2004 147.091

Unlicensed utilization review organizations, Minn. Statutes 2004 62M.03