19 Miss. Code. R. 3-19.15 - Change of patient status to emergency status after submission of prior authorization request

Notwithstanding language to the contrary elsewhere contained herein, if a licensed physician certifies in writing to an insurer within seventy-two (72) hours of an admission that the insured person admitted was in need of immediate hospital care for emergency services, such shall constitute a prima facie case of the medical necessity of the admission. To overcome this, the entity requesting the utilization review and/or the private review agent must show by clear and convincing evidence that the admitted person was not in need of immediate hospital care.

Notes

19 Miss. Code. R. 3-19.15

Miss. Code Ann. § 41-83-21 (Rev. 2023); Miss. Code Ann. §§ 83-5-901 through 83-5-937.

Adopted 1/1/2025