26.1-36.12-03. Personnel qualified to make adverse determinations
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ND Code › Title 26.1 › Chapter 26.1-36.12 › Section 26.1-36.12-03
Text
26.1-36.12-03. Personnel qualified to make adverse determinations
A prior authorization review organization shall ensure all adverse determinations are made
by a licensed physician or licensed pharmacist. The reviewing individual:
1. Must have experience treating patients with the condition or illness for which the health
care service is being requested; and
2. Shall make the adverse determination under the clinical direction of one of the prior
authorization review organization's medical directors who is responsible for the health
care services provided to enrollees.
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