215 ILCS 200/35

Current through Public Act 103-1052

Section 215 ILCS 200/35 - Personnel qualified to make adverse determinations of a prior authorization request

A health insurance issuer or its contracted utilization review organization must ensure that all adverse determinations are made by a physician when the request is by a physician or a representative of a physician. The physician must:

(1) possess a current and valid nonrestricted license in any United States jurisdiction; and

(2) have experience treating and managing patients with the medical condition or disease for which the health care service is being requested.

Notwithstanding the foregoing, a licensed health care professional who satisfies the requirements of this Section may make an adverse determination of a prior authorization request submitted by a health care professional licensed in the same profession.

215 ILCS 200/35

Added by P.A. 102-0409,§ 35, eff. 1/1/2022.