# Mont. Code Ann. § 33-32-207: 33-32-207 Health insurance issuer duties for utilization review > Montana · Statutes · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-207 ## Section - **Citation:** Mont. Code Ann. § 33-32-207 - **Heading:** 33-32-207 Health insurance issuer duties for utilization review - **Jurisdiction:** Montana - **Kind:** Statutes - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** MT Code / Title 33 / Chapter 32 / Part 2 / Section 33-32-207 ## Text 33-32-207 . Health insurance issuer duties for utilization review. (1) A health insurance issuer that requires a request for benefits under the covered person's health plan to be subjected to utilization review shall implement a utilization review program with written documentation describing all review activities and procedures, both delegated and nondelegated, for: (a) the filing of benefit requests; (b) the notification of utilization review and benefit determinations; and (c) the review of adverse determinations in accordance with Title 33, chapter 32, parts 3 and 4. (2) The written documentation must describe the following: (a) procedures to evaluate the medical necessity, appropriateness, efficacy, or efficiency of health care services; (b) data sources and clinical review criteria used in decisionmaking; (c) mechanisms to ensure consistent application of clinical review criteria and compatible decisions; (d) data collection processes and analytical methods used in assessing utilization of health care services; (e) provisions for ensuring confidentiality of clinical and proprietary information; (f) the organizational structure that periodically assesses utilization review activities and reports to the health insurance issuer's governing body. This organizational structure may include but is not limited to the utilization review committee or a quality assurance committee. (g) the staff position functionally responsible for day-to-day program management. (3) A health insurance issuer shall: (a) file an annual summary report of its utilization review program activities with the commissioner in the format specified by the commissioner; (b) maintain records for a minimum of 6 years of all benefit requests, claims, and notices associated with utilization review and benefit determinations made in accordance with 33-32-211 and 33-32-212 ; and (c) make the records maintained under subsection (3)(b) available, on request, for examination by covered persons, the commissioner, and appropriate federal agencies. ## Nearby sections - [Mont. Code Ann. § 33-32-202 33-32-202 Commissioner not to approve or disapprove plans](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-202.md) - [Mont. Code Ann. § 33-32-205 33-32-205 Corporate oversight of utilization review program](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-205.md) - [Mont. Code Ann. § 33-32-206 33-32-206 Responsibility for contracted services](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-206.md) - [Mont. Code Ann. § 33-32-207 33-32-207 Health insurance issuer duties for utilization review](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-207.md) - [Mont. Code Ann. § 33-32-208 33-32-208 Operational requirements](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-208.md) - [Mont. Code Ann. § 33-32-209 33-32-209 Exemption for continuity of care on change in health plans](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-209.md) - [Mont. Code Ann. § 33-32-210 33-32-210 Qualifications of individuals making or reviewing adverse determinations](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-210.md) - [Mont. Code Ann. § 33-32-211 33-32-211 Procedures for standard utilization review and benefit determinations -- notices](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-211.md) - [Mont. Code Ann. § 33-32-212 33-32-212 Procedures for expedited utilization review and benefit determinations](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-212.md) - [Mont. Code Ann. § 33-32-215 33-32-215 Emergency services](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-215.md) - [Mont. Code Ann. § 33-32-216 33-32-216 Confidentiality](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-216.md) - [Mont. Code Ann. § 33-32-217 33-32-217 Disclosure](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-217.md) - [Mont. Code Ann. § 33-32-221 33-32-221 Prior authorization requirements](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-221.md) - [Mont. Code Ann. § 33-32-222 33-32-222 Prohibition on prior authorization requirements for prescriptions written at discharge from inpatient care](https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-222.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_MT_T33_C32_P2_S33-32-207. Check the current official text before relying on it. Not legal advice.