S.D. Admin. R. 67:16:14:08

Current through Register Vol. 51, page 67, December 16, 2024

Section 67:16:14:08 - Utilization review

Utilization review for prescription drug services may be conducted on three levels:

(1) Computerized claims processing;

(2) Postpayment review; and

(3) Peer review.

S.D. Admin. R. 67:16:14:08

SL 1975, ch 16, § 1; 1 SDR 77, effective 5/29/1975; 7 SDR 66, 7 SDR 89, effective 7/1/1981; 9 SDR 164, effective 6/30/1983; 16 SDR 234, effective 7/1/1990.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Drug use review program and electronic claims management system for outpatient drug claims, 42 C.F.R. § 456.700.