|
SB 707 - Under this act, if a health carrier or health benefit plan provides coverage for diagnostic radiology testing and if a treating physician presents an order for a test to a radiology benefits manager for prior authorization, a decision to deny the authorization shall only be made by a licensed physician. When any decision to deny an authorization for diagnostic testing is made, the treating physician and the patient must be furnished with the name, address, telephone number, and employer of the radiology benefits manager physician who is making the denial decision. When a carrier, plan, or radiology benefits manager authorizes a test, the authorization will satisfy any requirement of medical necessity in the carrier's or plan's policy of benefits and the claim for payment shall be timely paid unless there was fraud on the part of the provider in procuring the authorization. Electronic clinical decision support tools which offer ordering guidance to physicians and can document the clinical appropriateness of the order are not subject to the provisions of this act. This act is identical to HB 1529 (2012) and similar to HB 982 (2011). ADRIANE CROUSE
|