# 18 Del. C. § 3373: §  3373. Utilization review entity’s obligation with respect to pre-authorization [For application of this section, see 85 Del. Laws, c. 176,  4] > Delaware · Statutes · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C33_SII_S3373 ## Section - **Citation:** 18 Del. C. § 3373 - **Heading:** §  3373. Utilization review entity’s obligation with respect to pre-authorization [For application of this section, see 85 Del. Laws, c. 176,  4] - **Jurisdiction:** Delaware - **Kind:** Statutes - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** Delaware Code / Title 18 / Chapter 33 / Subchapter II / Section 3373 ## Text (a) If a utilization review entity requires pre-authorization of a pharmaceutical, the utilization review entity must complete its process or render an adverse determination and notify the covered person’s health-care provider within 2 business days of obtaining a clean pre-authorization using services described in § 3377 of this title. (b) If a utilization review entity requires pre-authorization of a health-care service, the utilization review entity must grant a pre-authorization or issue an adverse determination and notify the covered person’s health-care provider of the determination within 5 business days of receipt of a clean pre-authorization not submitted using services described in § 3377 of this title. For purposes of this subsection, a clean pre-authorization includes the results of any face-to-face clinical evaluation or second opinion that may be required. (c) If a utilization review entity requires pre-authorization of a health-care service, the utilization review entity must grant a pre-authorization or issue an adverse determination and notify the covered person’s health-care provider of the determination within 3 business days of receipt of a clean pre-authorization submitted using services described in § 3377 of this title. For purposes of this subsection, a clean pre-authorization includes the results of any face-to-face clinical evaluation or second opinion that may be required. (d) If a utilization review entity requires pre-authorization of an urgent health-care service, the utilization review entity must grant a pre-authorization or issue an adverse determination and notify the covered person’s health-care provider of the determination within 24 hours of receipt of a clean pre-authorization submitted using services described in § 3377 of this title. For purposes of this subsection, a clean pre-authorization includes the results of any face-to-face clinical evaluation or second opinion that may be required. (e) (1) If a utilization review entity requires pre-authorization of a patient transfer, the utilization review entity must grant a pre-authorization or issue an adverse determination and notify the covered person’s health-care provider of the determination within 24 hours of receipt of a clean pre-authorization submitted using services described in § 3377 of this title. For purposes of this subsection, a clean pre-authorization includes the results of any face-to-face clinical evaluation or second opinion that may be required. (2) Notwithstanding the provisions in paragraph (e)(1) of this section, when an insurer, health-benefit plan, or health-service corporation has determined that a lower level of care at a health-care facility is clinically appropriate, the insurer, health-benefit plan, or health-service corporation may not require pre-authorization for medically necessary interfacility transport of the covered person. (f) If a utilization review entity requires pre-authorization of an urgent health-care service, the utilization review entity must grant a pre-authorization or issue an adverse determination and notify the covered person’s health-care provider of the determination within 48 hours of receipt of a clean pre-authorization submitted not using services described in § 3377 of this title. For purposes of this subsection, a clean pre-authorization includes the results of any face-to-face clinical evaluation or second opinion that may be required. (g) If a utilization review entity requires pre-authorization of a patient transfer, the review entity must grant a pre-authorization or issue an adverse determination and notify the covered person’s health-care provider of the determination within 48 hours of receipt of a clean pre-authorization not submitted using services described in § 3377 of this title. For purposes of this subsection, a clean pre-authorization includes the results of any face-to-face clinical evaluation or second opinion that may be required. ## Nearby sections - [18 Del. C. § 3371 §  3371. Definitions [For application of this section, see 82 Del. Laws, c. 44,  3; 85 Del. Laws, c. 176,  4].](https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C33_SII_S3371.md) - [18 Del. C. § 3372 §  3372. Disclosure and review of pre-authorization requirements; adverse determinations [For application of this section, see 85 Del. Laws, c. 176,  4].](https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C33_SII_S3372.md) - [18 Del. C. § 3373 §  3373. Utilization review entity’s obligation with respect to pre-authorization [For application of this section, see 85 Del. Laws, c. 176,  4].](https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C33_SII_S3373.md) - [18 Del. C. § 3374 §  3374. Utilization review entity’s obligations with respect to pre-authorization concerning emergency health-care services.](https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C33_SII_S3374.md) - [18 Del. C. § 3375 §  3375. Retrospective denial.](https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C33_SII_S3375.md) - [18 Del. C. § 3376 §  3376. Effect and length of pre-authorization; limitation per episode of care [For application of this section, see 85 Del. Laws, c. 176,  4].](https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C33_SII_S3376.md) - [18 Del. C. § 3377 §  3377. Electronic standards for pre-authorization [For application of this section, see 85 Del. Laws, c. 176,  4].](https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C33_SII_S3377.md) - [18 Del. C. § 3378 §  3378. Health-care services deemed preauthorized if a utilization review entity fails to comply with the requirements of this subchapter.](https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C33_SII_S3378.md) - [18 Del. C. § 3379 §  3379. Waiver prohibited.](https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C33_SII_S3379.md) - [18 Del. C. § 3380 §  3380. Exemptions.](https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C33_SII_S3380.md) - [18 Del. C. § 3381 §  3381. Step therapy exception process [For application of this section, see 82 Del. Laws, c. 44,  3].](https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C33_SII_S3381.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C33_SII_S3373. Check the current official text before relying on it. Not legal advice.