Iowa Admin. Code r. 191-70.1 - Purpose
The purpose of this chapter is to:
1. Promote the delivery of appropriate health
care in a cost-effective manner
2.
Ensure that any utilization review system used by a third-party payor adheres
to reasonable standards for conducting orderly and efficient utilization review
processes.
3. Ensure that any
utilization review system used by a third-party payor does not result in an
unfair discrimination between enrollees of essentially the same class or risk
in the benefits payable under a contract for health benefits.
4. Foster greater coordination and
cooperation between health care providers and utilization reviewers.
5. Improve communications and knowledge of
benefits among all parties concerned before expenses are incurred.
Notes
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