(a) A healthcare insurer is bound by an appeal or independent review organization determination that does not affirm the determination made by the healthcare insurer to rescind a prior authorization exemption.
(b) A healthcare insurer shall not retroactively deny a healthcare service on the basis of a rescission of an exemption, even if the healthcare insurer's determination to rescind the prior authorization exemption is affirmed by an independent review organization.
(c) If a determination of a prior authorization exemption made by the healthcare insurer is overturned on review by an independent review organization, the healthcare insurer:(1) Shall not attempt to rescind the exemption before the end of the next evaluation period; and(2) May only rescind the exemption if the healthcare insurer complies with §§ 23-99-1122 and 23-99-1123.
(1) Shall not attempt to rescind the exemption before the end of the next evaluation period; and
(2) May only rescind the exemption if the healthcare insurer complies with §§ 23-99-1122 and 23-99-1123.