33-46-20. Prior authorization requirements posted on website; statistical reporting.

An insurer shall make any current prior authorization requirements readily accessible on its website to healthcare providers. Clinical criteria on which an adverse determination is based shall be provided to the healthcare provider at the time of the notification.#

If an insurer intends either to implement a new prior authorization requirement or to amend an existing requirement, such insurer shall ensure that the new or amended requirement is not implemented unless such insurer’s website has been updated to reflect such addition or change.#

An insurer using prior authorization shall make aggregate statistics available per such insurer and per its plans regarding prior authorization approvals and denials on its website in a readily accessible format. The Commissioner shall determine the statistics required in order to comply with this Code section in accordance with applicable state and federal privacy laws. Such statistics shall include, but not be limited to, the following:#

1. (1)

   Approved or denied on initial request;#

2. (2)

   Reason for denial;#

3. (3)

   Whether appealed;#

4. (4)

   Whether approved or denied on appeal; and#

5. (5)

   Time between submission and response.#