(a) Each utilization review entity shall have written procedures for assuring that patient-specific information obtained during the process of utilization review shall be:
- (1) Kept confidential in accordance with applicable laws and rules;
- (2) Used solely for the purposes of utilization review, quality management, discharge planning, and case management;
- (3) Shared only with the claims administrator and other such persons who have authority to receive such information; and
- (4) Limited to the information necessary for the claims administrator to adjudicate the claim.
- (b) All data which provides sufficient information to allow identification of an individual patient, enrollee, or claimant shall be considered confidential medical information.
Source. #5931, eff 12-5-94, EXPIRED: 12-5-00 New. #7683, eff 6-1-02; ss by #9721-A, eff 6-11-10; ss by #12545, eff 6-11-18