A utilization review program shall use documented clinical review criteria that are based on sound clinical evidence and are evaluated periodically to assure ongoing efficacy. A health carrier may develop its own clinical review criteria, or it may purchase or license clinical review criteria from qualified vendors. A health carrier shall make available its clinical review criteria upon request to authorized government agencies.
Neb. Rev. Stat. § 44-5426
Utilization review program; use of clinical review criteria
Laws 1998, LB 1162, § 11.
Official source: Nebraska Legislature. Reproduced from public-domain Nebraska statutes; confirm against the official source for the current text. Not legal advice.