# Neb. Rev. Stat. § 44-5436: View Statute 44-5436

> Nebraska · Statutes · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-5436

## Section

- **Citation:** Neb. Rev. Stat. § 44-5436
- **Heading:** View Statute 44-5436
- **Jurisdiction:** Nebraska
- **Kind:** Statutes
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** NE Code / Chapter 44 / Section 44-5436

## Text

A utilization review agent shall ensure that all appeals of an adverse determination for prior authorization are reviewed by a physician. Such physician shall:

(1) Possess a current and valid unrestricted license in a United States jurisdiction;

(2) Be of the same or similar specialty as the ordering physician or have the training and experience to treat the condition, which means that either:

(a) The physician maintains board certification for the same or similar specialty; or

(b) The physician's training and experience (i) includes treating the condition, (ii) includes treating complications that may result from the health care service, and (iii) is sufficient for the physician to determine based on the physician's clinical judgment whether the health care service is medically necessary or clinically appropriate;

(3) Not have been directly involved in making the initial adverse determination;

(4) Not have any financial interest in the outcome of the appeal; and

(5) Consider all known clinical aspects of the health care service under review, including, but not limited to, a review of those medical records which are pertinent and relevant to the active condition provided to the utilization review agent by the enrollee's health care provider, or a health care facility, and any pertinent medical literature provided to the utilization review agent by the health care provider.

Laws 2025, LB77, § 5.

## Nearby sections

- [Neb. Rev. Stat. § 44-102 View Statute 44-102](https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-102.md)
- [Neb. Rev. Stat. § 44-102.01 View Statute 44-102.01](https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-102.01.md)
- [Neb. Rev. Stat. § 44-116 View Statute 44-116](https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-116.md)
- [Neb. Rev. Stat. § 44-133 View Statute 44-133](https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-133.md)
- [Neb. Rev. Stat. § 44-149 View Statute 44-149](https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-149.md)
- [Neb. Rev. Stat. § 44-152 View Statute 44-152](https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-152.md)
- [Neb. Rev. Stat. § 44-154 View Statute 44-154](https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-154.md)
- [Neb. Rev. Stat. § 44-161 View Statute 44-161](https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-161.md)
- [Neb. Rev. Stat. § 44-162 View Statute 44-162](https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-162.md)
- [Neb. Rev. Stat. § 44-163 View Statute 44-163](https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-163.md)
- [Neb. Rev. Stat. § 44-206 View Statute 44-206](https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-206.md)
- [Neb. Rev. Stat. § 44-208.03 View Statute 44-208.03](https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-208.03.md)
- [Neb. Rev. Stat. § 44-208.08 View Statute 44-208.08](https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-208.08.md)
- [Neb. Rev. Stat. § 44-218 View Statute 44-218](https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-218.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_NE_C44_S44-5436. Check the current official text before relying on it. Not legal advice.