MO HB1799

Repeal and replace section 376.1363 of Missouri law regarding health carrier utilization review procedures and decision-making timelines

Reduce initial determination timeframe from two working days to twenty-four hours after obtaining all necessary information for proposed admissions, procedures, or services

Require health carriers to notify providers by telephone or electronically within twenty-four hours for certifications and within twenty-four hours for adverse determinations, with written confirmation within one to two working days

Maintain concurrent review determinations within one working day, with telephone/electronic notification to providers within one working day for certifications and within twenty-four hours for adverse determinations

Require written adverse determination notices to include principal reasons, appeal instructions, and clinical rationale upon request; maintain thirty working day timeline for retrospective reviews with ten working day notice requirement