As used in this chapter:

1. (1) "Utilization review" means a system for reviewing the necessary, appropriate, and efficient allocation of health care resources and services given or proposed to be given to a patient or group of patients.

2. (2) "Private review agent" means a person performing utilization reviews who is either under contract with or acting on behalf of, but not employed by:

   1. (a) a South Carolina business entity;
   2. (b) the State of South Carolina; or
   3. (c) a hospital.
3. (3) "Utilization review program" means an overview of the activities performed by the private review agent.
4. (4) "Director or his designee" means the director or his designee of the South Carolina Department of Insurance. The director may appoint a designee or deputy director to assist in the management and operation of the department. If the director does not appoint a designee or deputy director, the term "director or his designee" shall be construed to refer to the director of the department.
5. (5) "Certificate" means a renewable certificate of registration granted by the director or his designee to a private review agent, authorizing the agent to perform utilization review activities in this State for two years. This certificate is not transferable.

HISTORY: 1990 Act No. 311, Section 2; 1993 Act No. 181, Sections 744, 745; 1994 Act No. 339, Section 18.