MN SF3606

Allows utilization review organizations to request additional information when there is significant disagreement with providers about service certification, defined as when the organization has tentatively denied certification, referred to a certified physician, and contacted the attending provider.

Requires initial utilization review determinations to be communicated within ten business days of request, with failure to respond deemed an approval; notification of denials must occur within one working day by phone, fax, or email.

Mandates that denials include the principal reasons for the determination and appeal procedures, provided in a culturally and linguistically appropriate manner consistent with the Affordable Care Act.

Requires standard appeals be decided within 30 days (extendable up to 14 additional days), with appeals reviewed by a different physician than the initial reviewer; successful appeals must include complete findings, reviewer qualifications, and the relationship between diagnosis and review criteria.

Specifies that physicians conducting clinical reviews must be certified to perform the procedure, licensed in Minnesota (with limited exceptions), and ensures they are reasonably available to discuss determinations; removes the provision allowing utilization review organizations to establish medically appropriate performance standards.