26.1-36.12-07. Prior authorization - Emergency medical condition

26.1-36.12-07. Prior authorization - Emergency medical condition

1. A prior authorization review organization may not require prior authorization for

prehospital transportation or for the provision of emergency health care services for an

emergency medical condition.

2. A prior authorization review organization shall allow an enrollee and the enrollee's

health care provider a minimum of two business days following an emergency

admission or provision of emergency health care services for an emergency medical

condition for the enrollee or health care provider to notify the prior authorization review

organization of the admission or provision of health care services.

3. The medical necessity or appropriateness of emergency health care services for an

emergency medical condition may not be based on whether those services were

provided by participating or nonparticipating providers.

4. If an enrollee receives an emergency health care service that requires immediate

postevaluation or poststabilization services, a prior authorization review organization

shall make an authorization determination within two business days of receiving a

request. If the authorization determination is not made within two business days, the

services must be deemed approved.