Title 83, Insurance

(a) The Mississippi Legislature finds and declares that:(a) The health care professional-patient relationship is paramount and should not be subject to unreasonable third-party interference;(b) Prior authorization programs may be subject to member coverage agreements and medical …

This article applies to every health insurance issuer and all health benefit plans, as both terms are defined in Section 83-9-6.3, and all private review agents and utilization review plans, as both terms are defined in Section 41-83-1, with the exception of employee or employer …

(a) For purposes of this article, unless the context requires otherwise, the following terms shall have the meanings as defined in this section:(a) “Adverse determination” means a determination by a health insurance issuer that, based on the information provided, a request for a …

(1) A health insurance issuer shall maintain a complete list of services for which prior authorization is required, including for all services where prior authorization is performed by an entity under contract with the health insurance issuer. (2) A health insurance issuer shall …

(1) If any health insurance issuer requires prior authorization of a health care service, the insurer or its designee utilization review organization shall, by January 1, 2025, make available a standardized electronic prior authorization request transaction process using an inter…

If a health insurance issuer requires prior authorization of a health care service, the health insurance issuer must make an approval or adverse determination and notify the enrollee, the enrollee’s health care professional, and the enrollee’s health care provider of the approval…

(1) If requested by a treating health care provider or health care professional for an enrollee, a health insurance issuer must render an approval or adverse determination concerning urgent health care services and notify the enrollee, the enrollee’s health care professional and …

(a) If a health insurance issuer makes an adverse determination, the health insurance issuer shall include the following in the notification to the enrollee, the enrollee’s health care professional, and the enrollee’s health care provider:(a) The reasons for the adverse determina…

(1) A health insurance issuer must ensure that all appeals are reviewed by a physician when the request is by a physician or a representative of a physician. The physician must:(a) Possess a current and valid nonrestricted license to practice medicine in any United States jurisdi…

(a) A health insurance issuer shall periodically review its prior authorization requirements and consider removal of prior authorization requirements:(a) Where a medication or procedure prescribed is customary and properly indicated or is a treatment for the clinical indication a…

(1) A health insurance issuer may not revoke or further limit, condition or restrict a previously issued prior authorization approval while it remains valid under this article. (2) Notwithstanding any other provision of law, if a claim is properly coded and submitted timely to a …

(1) A prior authorization approval shall be valid for the lesser of six (6) months after the date the health care professional or health care provider receives the prior authorization approval or the length of treatment as determined by the patient’s health care professional or t…

(1) If a health insurance issuer requires a prior authorization for a recurring health care service or maintenance medication for the treatment of a chronic or long-term condition, including, but not limited to, chemotherapy for the treatment of cancer, the approval shall remain …

(1) On receipt of information documenting a prior authorization approval from the enrollee or from the enrollee’s health care professional or health care provider, a health insurance issuer shall honor a prior authorization granted to an enrollee from a previous health insurance …

A failure by a health insurance issuer to comply with the deadlines and other requirements specified in this article shall result in any health care services subject to review to be automatically deemed authorized by the health insurance issuer or its contracted private review ag…

(1) In addition to the enforcement powers granted to it by law to enforce the provisions of this article, the department is granted specific authority to issue a cease-and-desist order or require a private review agent or health insurance issuer to submit a plan of correction for…

(1) By June 1, 2025, and each June 1 after that date, a health insurance issuer shall report to the department, on a form issued by the department, the following aggregated trend data, de-identified of protected health information, related to the insurer’s practices and experienc…

If a health insurance issuer has clear and convincing evidence that a health care professional or health care provider has knowingly and willingly submitted false or fraudulent requests for prior authorization to the health insurance issuer, the issuer shall notify and provide th…