Department of Labor and Regulation

Title - Division of Insurance email the Division of Insurance

Health Rate & Form Filing Requirements for
Managed Care

Requirements from South Dakota Codified Law (SDCL)
Statute
Topic
58-17F-1 Definitions. Terms used in this chapter mean ...
58-17H-28 Prospective review determinations--Timing--Notification of requirements- -Extension of time.
58-17H-29 Concurrent review determinations--Timing--Notification requirements.
58-17H-30 Retrospective review determinations--Timing--Notification requirements.
58-17H-32 Notification of adverse determination--Contents.
58-17H-33 Information required to be provided to covered persons and prospective covered persons.
58-17H-40 Urgent care requests--Written procedures for receipt and determination of requests required.
58-17H-43 Urgent care requests--Timely notification of determination.
58-17H-41 Insufficient information for determination--Notice and statement of necessary information required.
58-17H-42 Insufficient information for determination of prospective urgent care requests.
58-17H-44 Time within which to submit necessary information.
58-17H-45 Urgent care requests--Notice of determination--Failure to submit necessary information as grounds for denial of certification.
58-17H-46 Concurrent review urgent care requests--Extended care requests--Time for determination and notice.
58-17H-47 Calculation of time periods for determinations.
58-17H-48 Notification of adverse determinations--Requirements.
58-17I-7 Review of adverse determinations--Time for filing--Designation and notice of reviewers--Scope of review. 
58-17I-8 Rights of covered person or authorized representative on review--Access to documentation.
58-17I-9 Time for decision and notice--Calculation of time periods.
58-17I-11 Issuance of decision--Required contents.
58-17I-1 Expedited review for adverse determinations involving urgent care requests--Appointment of peers for review.
58-17F-13 Transmission of necessary information for certain expedited reviews.
58-17F-14 Expedited review decision not initial determination for benefits--Notification--Time periods--Continuation of service involving concurrent review urgent care requests.
58-17F-15 Expedited review decision--Notification--Required contents.
Requirements from Administrative RulesĀ of South Dakota
20:06:34:11 Scope of retrospective review




 

 


Division of Insurance
124 S. Euclid Ave., 2nd Floor
Pierre, SD 57501
Tel. 605.773.3563
Fax. 605.773.5369