™Your Policy Risk Impact Agent
66 chapters · 1,628 sections in this title.
S.C. Code Ann. § 38-70-10 Definitions
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As used in this chapter: (1) "Utilization review" means a system for reviewing the necessary, appropriate, and efficient allocation of health care resources and services given or proposed to be given to a patient or group of patients. (2) "Private review agent" means a person per…
S.C. Code Ann. § 38-70-15 Applicability of chapter
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This chapter applies to insurance companies, administrators of insurance benefit plans, and health maintenance organizations licensed and regulated by the South Carolina Department of Insurance. Insurance companies, administrators of insurance benefit plans, and health maintenanc…
S.C. Code Ann. § 38-70-20 Certificate to perform activities; applications; fees; minimum standards; confidentiality of records
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(A) No private review agent may conduct utilization reviews in this State unless the director or his designee has granted the private review agent a certificate to perform these activities. The director or his designee, in his discretion, may approve or deny certificate applicati…
S.C. Code Ann. § 38-70-30 Renewal of certificate
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A certificate must be renewed on the second anniversary of its effective date and is considered to be approved upon payment of the fee unless the director or his designee takes action to withdraw or cancel the certificate.
