# 18 Del. C. § 3583: §  3583. Utilization review entity’s obligations with respect to pre-authorizations [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_C35_SV_S3583 ## Section - **Citation:** 18 Del. C. § 3583 - **Heading:** §  3583. Utilization review entity’s obligations with respect to pre-authorizations [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 35 / Subchapter V / Section 3583 ## 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 or of using services described in § 3587 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 § 3587 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 § 3587 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 § 3587 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 § 3587 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 § 3587 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 § 3387 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. § 3581 §  3581. 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_C35_SV_S3581.md) - [18 Del. C. § 3582 §  3582. 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_C35_SV_S3582.md) - [18 Del. C. § 3583 §  3583. Utilization review entity’s obligations with respect to pre-authorizations [For application of this section, see 85 Del. Laws, c. 176,  4].](https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C35_SV_S3583.md) - [18 Del. C. § 3584 §  3584. 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_C35_SV_S3584.md) - [18 Del. C. § 3585 §  3585. Retrospective denial.](https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C35_SV_S3585.md) - [18 Del. C. § 3586 §  3586. 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_C35_SV_S3586.md) - [18 Del. C. § 3587 §  3587. 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_C35_SV_S3587.md) - [18 Del. C. § 3588 §  3588. 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_C35_SV_S3588.md) - [18 Del. C. § 3589 §  3589. Waiver prohibited.](https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C35_SV_S3589.md) - [18 Del. C. § 3590 §  3590. Exemptions.](https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C35_SV_S3590.md) - [18 Del. C. § 3591 §  3591. 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_C35_SV_S3591.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_DE_T18_C35_SV_S3583. Check the current official text before relying on it. Not legal advice.