Section 27-1-37.5-17 - Peer to peer review; request(a) As used in this section, "necessary information" includes the results of any face-to-face clinical evaluation, second opinion, or other clinical information that is directly applicable to the requested service that may be required.(b) If a health plan makes an adverse determination on a prior authorization request by a covered individual's health care provider, the health plan must offer the covered individual's health care provider the option to request a peer to peer review by a clinical peer concerning the adverse determination.(c) A covered individual's health care provider may request a peer to peer review by a clinical peer either in writing or electronically.(d) If a peer to peer review by a clinical peer is requested under this section: (1) the health plan's clinical peer and the covered individual's health care provider or the health care provider's designee shall make every effort to provide the peer to peer review not later than seven (7) business days from the date of receipt by the health plan of the request by the covered individual's health care provider for a peer to peer review if the health plan has received the necessary information for the peer to peer review; and(2) the health plan must have the peer to peer review conducted between the clinical peer and the covered individual's health care provider or the provider's designee.Added by P.L. 190-2023,SEC. 18, eff. 7/1/2023.