Directs the establishment of a pool of utilization review agents from health services specialties; requires impartiality; provides for the appointment of agents from the pool; requires random review of utilization review records; prohibits conflicts of interest.
Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.
Relates to utilization review program standards; requires use of evidence-based and peer reviewed clinical review criteria; relates to prescription drug formulary changes and pre-authorization for certain health care services.