Utilization review.
Effective Jul 5, 199016 SDR 235Source: SL 1975, ch 16, § 1; 1 SDR 30, effective October 13, 1974; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 15 SDR 2, effective July 17, 1988; 16 SDR 235, effective July 5, 1990. | General Authority: SDCL 28-6-1. | Law Implemented: SDCL 28-6-1.
The department may review inpatient hospital service claims for the following information:
- (1) Necessity of admission;
- (2) Length of stay;
- (3) Coding;
- (4) Computerized claims processing;
- (5) Post-payment review; and
- (6) Peer review.
Source: SL 1975, ch 16, § 1; 1 SDR 30, effective October 13, 1974; 7 SDR 66, 7 SDR 89, effective July 1, 1981; 15 SDR 2, effective July 17, 1988; 16 SDR 235, effective July 5, 1990.
General Authority: SDCL 28-6-1.
Law Implemented: SDCL 28-6-1.