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Utilization Review Act

Chapter 3A of Section 27 of the Alabama State Code contains the Health Care Service Utilization Review Act . Utilization review agents ensure compliance to and adherence of regulations set forth in this act.

  1. Purpose

    • Alabama state legislature passed the Health Care Service Utilization Review Act to promote quality, cost-effective health care, ensure utilization review agents adhere to review conduct standards outlined in Section 27-3A-5, encourage coordination and cooperation between health care providers and utilization review agents, improve communication of benefit plan requirements and ensure confidentiality of medical records.

    Definition

    • The Alabama State Code defines utilization review as a system for reviewing the need for and appropriateness of allocating health care resources and services to individuals within Alabama.

    Violations

    • According to Section 27-3A-6 of the Alabama State Code, a business that incurs a utilization review violation frequently enough that the agent considers it a general business practice or pattern is subject to an administrative fine of up to $5,000.

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