Title 33 — Title 33
0 chapters · 1,218 sections in this title.
O.C.G.A. § 33-46-1 Legislative purposes and intent
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(a) The purpose of this chapter is to promote the delivery of quality health care in Georgia. Furthermore, it is to foster the delivery of such care in a cost-effective manner through greater coordination between health care providers, claims administrators, payors, employers, pa…
O.C.G.A. § 33-46-10 Reporting requirements
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The Commissioner shall establish such reporting requirements upon private review agents as are necessary to determine if the utilization review programs are in compliance with the provisions of this chapter and applicable rules and regulations. History. — Code 1981, § 33-46-10, e…
O.C.G.A. § 33-46-11 Insurance companies
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Administrators. Licensing of administrators, §§33-23-104, 33-23-105. Agents, subagents, counselors and adjusters, §33-23-44. Corporate governance annual disclosure, §33-65-4. Division of domestic insurers, §33-14-128. Insider trading of domestic stock insurer equity securities, §…
O.C.G.A. § 33-46-12 Exemptions from certificate requirements
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No certificate is required for utilization review by any Georgia licensed pharmacist or pharmacy while engaged in the practice of pharmacy, including but not limited to review of the dispensing of drugs, participation in drug utilization review, and monitoring patient drug therapy…
O.C.G.A. § 33-46-13 Exemptions from applicability of chapter
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(a) This chapter shall not apply to any contract with the federal government for utilization and review of patients eligible for hospital services under Title XVIII or XIX of the Social Security Act. (b) This chapter shall not apply to any private review agent when such private r…
O.C.G.A. § 33-46-14 Commissioner to issue annual report
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The Commissioner shall issue an annual report to the Governor and the General Assembly concerning the conduct of utilization review in this state. Such report shall include a description of utilization review programs and the services they provide, an analysis of complaints filed …
O.C.G.A. § 33-46-2 Definitions
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As used in this chapter, the term: (1) ‘‘Certificate’’ means a certificate of registration granted by the Commissioner to a private review agent. (2) ‘‘Claim administrator’’ means any entity that reviews and determines whether to pay claims to enrollees of health care providers on …
O.C.G.A. § 33-46-3 Certification of private review agents; exemption
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(a) A private review agent may not conduct utilization review of health care provided in this state unless the Commissioner has granted the private review agent a certificate pursuant to this chapter. No individual conducting utilization review shall require certification if 920 33…
O.C.G.A. § 33-46-4 Requirements for certification
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As a condition of certification or renewal thereof, a private review agent shall be required to maintain compliance with the following: (1) The medical protocols including reconsideration and appeal processes as well as other relevant medical issues used in the private review prog…
O.C.G.A. § 33-46-5 Certificate application fees; information to be submitted with application
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(a) An applicant for a certificate shall submit an application on a form prescribed by the Commissioner and pay an application fee and a certificate fee as provided in Code Section 33-8-1. The application shall be signed and verified by the applicant. 922 33-46-6 (b) In conjunction …
O.C.G.A. § 33-46-6 Expiration and renewal of certificate
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(a) A certificate shall expire on the second anniversary of its effective date unless the certificate is renewed for a two-year term as provided in this Code section. (b) Before the certificate expires but no sooner than 90 days prior to such expiration, a certificate may be renewed …
O.C.G.A. § 33-46-7 Legislative purposes and intent
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Definitions. Certification of private review agents; exemption. Requirements for certification. Certificate application fees; information to be submitted with application. Expiration and renewal of certificate. Jurisdiction of Commissioner over private review agents.
O.C.G.A. § 33-46-8 Legislative declaration, §33-46-1
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Pharmacists and pharmacies. Exemption from certification requirement, §33-46-12. Purposes of provisions, §33-46-1. Reports. Commissioner of insurance. Annual report, §33-46-14. Establishment of reporting requirements, §33-46-10. Rules and regulations. Commissioner of insurance, §3…
O.C.G.A. § 33-46-9 Listings of certificate holders
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The Commissioner shall periodically, not less than once a year, provide a list of private review agents issued certificates and the renewal date for those certificates to all hospitals and to any other individual or organization requesting such list. History. — Code 1981, § 33-46-9…