RSA 420-E:4 Minimum Standards; Licensure of Medical Utilization Review Entities.

All licensees shall establish and maintain a utilization review procedure by which a claimant or claimant's representative may seek a claim benefit determination. The procedure shall meet the following minimum standards:
I. The licensee shall maintain a toll-free telephone number to ensure that a representative of the licensee shall be accessible by telephone to insureds, patients, and providers 7 days a week during normal working hours.
II. Claim benefit determinations shall be made by a licensed or certified health care provider.
III. Clinical review criteria considered or utilized in making claim benefit determinations shall be:
(a) Developed with input from appropriate actively practicing practitioners in the carrier or other licensed entity's service are