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New Hampshire Statutes, Title XXXVII

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New Hampshire/Statutes

← All New Hampshire coverage

Title XXXVII, Insurance

116 chapters · 1,704 sections in this title.

All chapters in Title XXXVII1,704 Ch 41590 Ch 40265 Ch 402-C61 Ch 420-J60 Ch 40558 Ch 400-A54 Ch 41247 Ch 420-B47 Ch 420-A42 Ch 411-A38 Ch 40837 Ch 41837 Ch 420-D35 Ch 41732

12 sections·Filtered byTitle XXXVII✕Ch 420-E✕

RSA 420-E:1 Definitions
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In this chapter: I. "Commissioner" means the insurance commissioner. I-a. "Claim involving urgent care" means any claim for medical care or treatment with respect to which the application of the time periods for making non-urgent care determinations: (a) Could seriously jeopardiz…
RSA 420-E:2 Licensure or Registration Required
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I. Any person, partnership or corporation, other than an insurer, nonprofit service organization, health maintenance organization, or an employee of those exempt organizations, that performs medical utilization review services on behalf of commercial insurers, nonprofit service o…
RSA 420-E:2-a Medical Director
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Every medical utilization review entity licensed by the department under this chapter shall employ one or more medical directors licensed under RSA 329 or, in the case of a dental utilization review entity, a dentist licensed under RSA 317-A.
RSA 420-E:3 Information Required
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[Paragraph I(intro. par.) effective until January 1, 2027; see also paragraph I(intro. par.) set out below.] I. Each person, partnership or corporation licensed under this chapter shall, at the time of initial licensure and on or before April 1 of each succeeding year, provide th…

RSA 420-E:4 Minimum Standards; Licensure of Medical Utilization Review Entities

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All licensees shall establish and maintain a utilization review procedure by which a claimant or claimant's representative may seek a claim benefit determination. The procedure shall meet the following minimum standards: I. The licensee shall maintain a toll-free telephone number…

RSA 420-E:4-a Uniform Prior Authorization Forms and Electronic Standard for Prescription Drug Benefits

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I. Beginning July 1, 2017, all health insurers, health maintenance organizations, health services corporations, medical services corporations, and preferred provider programs may, when requiring prior authorization for a prescription drug, use and accept the prior authorization p…

RSA 420-E:4-b Prior Authorization Standards for Managed Care Plans

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The following prior authorization requirements apply to utilization review entities conducting prior authorization review determinations for managed care plans operating subject to RSA 420-J. I. Timeliness standards for processing prior authorization requests submitted electronic…

RSA 420-E:5 Listing

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The commissioner shall compile and maintain a current listing of persons, partnerships or corporations licensed pursuant to this chapter. The list shall be available to the public.

RSA 420-E:6 Periodic Reviews

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The commissioner or designee may conduct periodic reviews of the operations of the entities licensed under this chapter to ensure that they continue to meet the minimum standards set in RSA 420-E:4 and any applicable rules adopted by the commissioner. The commissioner may perform…

RSA 420-E:7 Rulemaking

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The commissioner shall adopt rules, under RSA 541-A and after public hearing, relative to: I. Procedures for application for license under RSA 420-E:2. II. Initial application fees and annual license fees. III. The time period for notification of determination as required under R…

RSA 420-E:8 Enforcement; Administrative Fine; Hearings

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I. The commissioner may take appropriate action against a licensee which fails to meet the standards under this chapter or any rules adopted by the commissioner, or who fails to respond in a timely manner to corrective actions ordered by the commissioner. The commissioner may imp…

RSA 420-E:9 Rulings on Appropriateness of Medical Judgments Not Authorized

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Nothing in this chapter requires or authorizes the commissioner to rule on the appropriateness of medical decisions or judgments rendered by review entities and their agents.