# N.D. Cent. Code § 26.1-36.12-03: 26.1-36.12-03. Personnel qualified to make adverse determinations

> North Dakota · Statutes · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-03

## Section

- **Citation:** N.D. Cent. Code § 26.1-36.12-03
- **Heading:** 26.1-36.12-03. Personnel qualified to make adverse determinations
- **Jurisdiction:** North Dakota
- **Kind:** Statutes
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** 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.

## Nearby sections

- [N.D. Cent. Code § 26.1-36.12-01 26.1-36.12-01. Definitions](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-01.md)
- [N.D. Cent. Code § 26.1-36.12-02 26.1-36.12-02. Disclosure and review of prior authorization requirements](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-02.md)
- [N.D. Cent. Code § 26.1-36.12-03 26.1-36.12-03. Personnel qualified to make adverse determinations](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-03.md)
- [N.D. Cent. Code § 26.1-36.12-04 26.1-36.12-04. Personnel qualified to review appeals](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-04.md)
- [N.D. Cent. Code § 26.1-36.12-05 26.1-36.12-05. Prior authorization - Nonurgent circumstances](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-05.md)
- [N.D. Cent. Code § 26.1-36.12-06 26.1-36.12-06. Prior authorization - Urgent health care services](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-06.md)
- [N.D. Cent. Code § 26.1-36.12-07 26.1-36.12-07. Prior authorization - Emergency medical condition](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-07.md)
- [N.D. Cent. Code § 26.1-36.12-08 26.1-36.12-08. No prior authorization for medication-assisted treatment](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-08.md)
- [N.D. Cent. Code § 26.1-36.12-09 26.1-36.12-09. Retrospective denial](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-09.md)
- [N.D. Cent. Code § 26.1-36.12-10 26.1-36.12-10. Length of prior authorization](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-10.md)
- [N.D. Cent. Code § 26.1-36.12-11 26.1-36.12-11. Chronic or long-term care conditions](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-11.md)
- [N.D. Cent. Code § 26.1-36.12-12 26.1-36.12-12. Continuity of care for enrollees](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-12.md)
- [N.D. Cent. Code § 26.1-36.12-13 26.1-36.12-13. Failure to comply - Services deemed authorized](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-13.md)
- [N.D. Cent. Code § 26.1-36.12-14 26.1-36.12-14. Procedures for appeals of adverse determinations](https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-14.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_ND_T26.1_C26.1-36.12_S26.1-36.12-03. Check the current official text before relying on it. Not legal advice.