Bill > S594

This bill aims to address the issue of duplicative notifications of utilization review (UR) approvals, which is an administrative simplification measure. The key provisions of the bill are: (1) It amends the existing law by striking out subsections (b) and (c) of Section 12 of Chapter 176O of the General Laws and inserting new subsections. (2) The new subsection (b) requires carriers or utilization review organizations to make an initial determination regarding a proposed admission, procedure, or service within two working days of obtaining all necessary information, and to notify the provider within 24 hours in case of an approval or within 24 hours and provide written or electronic confirmation within one working day in case of an adverse determination. (3) The new subsection (c) requires carriers or utilization review organizations to make a concurrent review determination within one working day of obtaining all necessary information, and to notify the provider within one working day in case of an approval or within 24 hours and provide written or electronic notification to the insured and the provider within one working day in case of an adverse determination.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/193/S594