Iowa Admin. Code r. 191-70.1

Current through Register Vol. 47, No. 13, December 25, 2024

Rule 191-70.1 - Purpose

The purpose of this chapter is to:

1. Promote the delivery of appropriate health care in a cost-effective manner

2. Ensure that any utilization review system used by a third-party payor adheres to reasonable standards for conducting orderly and efficient utilization review processes.

3. Ensure that any utilization review system used by a third-party payor does not result in an unfair discrimination between enrollees of essentially the same class or risk in the benefits payable under a contract for health benefits.

4. Foster greater coordination and cooperation between health care providers and utilization reviewers.

5. Improve communications and knowledge of benefits among all parties concerned before expenses are incurred.

Iowa Admin. Code r. 191-70.1