62M.01 CITATION, JURISDICTION, AND SCOPE.
Subdivision 1. Popular name.
may be cited as the "Minnesota
Utilization Review Act of 1992."
Subd. 2. Jurisdiction.
apply to any insurance company licensed
under chapter 60A to offer, sell, or issue a policy of accident and sickness insurance as defined
; a health service plan licensed under chapter 62C; a health maintenance
organization licensed under chapter 62D; the Minnesota Comprehensive Health Association
created under chapter 62E; a community integrated service network licensed under chapter 62N;
an accountable provider network operating under chapter 62T; a fraternal benefit society operating
under chapter 64B; a joint self-insurance employee health plan operating under chapter 62H; a
multiple employer welfare arrangement, as defined in section 3 of the Employee Retirement
Income Security Act of 1974 (ERISA), United States Code, title 29, section 1103, as amended; a
third party administrator licensed under section
60A.23, subdivision 8
, that provides utilization
review services for the administration of benefits under a health benefit plan as defined in section
; or any entity performing utilization review on behalf of a business entity in this state
pursuant to a health benefit plan covering a Minnesota resident.
Subd. 3. Scope.
Nothing in sections
applies to review of claims
after submission to determine eligibility for benefits under a health benefit plan. The appeal
procedure described in section
applies to any complaint as defined under section
, that requires a medical determination in its resolution.
History: 1992 c 574 s 1; 1999 c 239 s 3; 2006 c 255 s 31