Utilization review agents monitor health care professionals for compliance with the act.
Chapter 3A of Section 27 of the Alabama State Code contains the Health Care Service Utilization Review Act . Utilization review agents ensure compliance to and adherence of regulations set forth in this act.
Purpose
Alabama state legislature passed the Health Care Service Utilization Review Act to promote quality, cost-effective health care, ensure utilization review agents adhere to review conduct standards outlined in Section 27-3A-5, encourage coordination and cooperation between health care providers and utilization review agents, improve communication of benefit plan requirements and ensure confidentiality of medical records.
Definition
The Code defines as a system for reviewing the need for and appropriateness of allocating health care resources and services to individuals within Alabama.
Violations
According to Section 27-3A-6 of the Alabama State Code, a business that incurs a utilization review violation frequently enough that the agent considers it a general business practice or pattern is subject to an administrative fine of up to $5,000.
Tags: review agents, utilization review, Alabama State Code, State Code, Alabama State, Care Service