26.1-36.12-02. Disclosure and review of prior authorization requirements

26.1-36.12-02. Disclosure and review of prior authorization requirements

1. A prior authorization review organization shall make any prior authorization

requirements and restrictions readily accessible on the organization's website to

enrollees, health care professionals, and the general public. Requirements include the

written clinical criteria and be described in detail using plain and ordinary language

comprehensible by a layperson.

2. If a prior authorization review organization intends to implement a new prior

authorization requirement or restriction, or amend an existing requirement or

restriction, the prior authorization review organization shall:

a. Ensure the new or amended requirement is not implemented unless the prior

authorization review organization's website has been updated to reflect the new

or amended requirement or restriction; and

b. Provide contracted health care providers of enrollees written notice of the new or

amended requirement or amendment no fewer than sixty days before the

requirement or restriction is implemented.