62M.07 PRIOR AUTHORIZATION OF SERVICES.
(a) Utilization review organizations conducting prior authorization of services must have
written standards that meet at a minimum the following requirements:
(1) written procedures and criteria used to determine whether care is appropriate, reasonable,
or medically necessary;
(2) a system for providing prompt notification of its determinations to enrollees and
providers and for notifying the provider, enrollee, or enrollee's designee of appeal procedures
under clause (4);
(3) compliance with section
62M.05, subdivisions 3a and 3b
, regarding time frames for
approving and disapproving prior authorization requests;
(4) written procedures for appeals of denials of prior authorization which specify the
responsibilities of the enrollee and provider, and which meet the requirements of sections
, regarding release of summary review findings; and
(5) procedures to ensure confidentiality of patient-specific information, consistent with
(b) No utilization review organization, health plan company, or claims administrator may
conduct or require prior authorization of emergency confinement or emergency treatment. The
enrollee or the enrollee's authorized representative may be required to notify the health plan
company, claims administrator, or utilization review organization as soon after the beginning of
the emergency confinement or emergency treatment as reasonably possible.
(c) If prior authorization for a health care service is required, the utilization review
organization, health plan company, or claim administrator must allow providers to submit requests
for prior authorization of the health care services without unreasonable delay by telephone,
facsimile, or voice mail or through an electronic mechanism 24 hours a day, seven days a week.
This paragraph does not apply to dental service covered under MinnesotaCare, general assistance
medical care, or medical assistance.
History: 1992 c 574 s 7; 1994 c 485 s 65; 1995 c 234 art 8 s 12; 1999 c 239 s 25; 2004
c 246 s 1