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79 chapters · 3,426 sections in this title.
SDCL § 58-17I-1 Definitions
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Terms used in this chapter mean: (1) "Adverse determination," any of the following: (a) A determination by a health carrier or the carrier's designee utilization review organization that, based upon the information provided, a request by a covered person for a benefit under the h…
SDCL § 58-17I-10 Procedures for providing new or additional evidence
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Prior to issuing a decision in accordance with the timeframes provided in § 58-17I-9 , the health carrier shall provide free of charge to covered person, or the covered person's authorized representative, any new or additional evidence, relied upon or generated by the health carr…
SDCL § 58-17I-11 Issuance of decision--Required contents
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The decision issued pursuant to § 58-17I-9 shall set forth in a manner calculated to be understood by the covered person or, if applicable, the covered person's authorized representative and include the following: (1) The titles and qualifying credentials of any person participat…
SDCL § 58-17I-12 Expedited review for adverse determinations involving urgent care requests--Appointment of peers for review
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Each health carrier shall establish written procedures for the expedited review of urgent care requests of grievances involving an adverse determination. In addition, a health carrier shall provide expedited review of a grievance involving an adverse determination with respect to…
