(a)

1. (1) The purpose of this section is to define certain minimum standards for insurers utilizing precertification or preauthorization reviews to ensure that such cost-containment procedures of disability insurers and healthcare plans are reasonable and do not unduly delay, interfere with, or impede the authorized practice of medicine and delivery of reasonable medical care.
2. (2) For purposes of this rule, acts of the claims administrator in performing precertification reviews shall be deemed to be acts of the insurer.

(b) From and after one hundred eighty (180) days from the effective date of this rule, insurers utilizing such reviews shall establish reasonable procedures to:

1. (1) Ensure that precertification reviews are completed in a prompt and timely manner;
2. (2) Avoid excessive, repetitious, and duplicative requests for information to claimants and their healthcare providers;
3. (3) Provide for reconsideration or medical reviews following disapproval or denial of precertification requests of insureds and claimants; and
4. (4) Provide for prompt peer medical review following disapproval or denial of precertification requests of insureds or claimants as to medically-necessary and/or life-threatening major surgical procedures.