(215 ILCS 200/30)
Sec. 30. Health insurance issuer's and its contracted utilization review organization's obligations with respect to prior authorizations concerning urgent health care services.
(a) Notwithstanding any other provision of law, a health insurance issuer or its contracted utilization review organization must render an approval or adverse determination concerning urgent care services and notify the enrollee, the enrollee's health care professional, and the enrollee's health care provider of that approval or adverse determination as required by law, but not later than 48 hours after receiving all information needed to complete the review of the requested health care services.
(b) To facilitate the rendering of a prior authorization determination in conformance with this Section, a health insurance issuer or its contracted utilization review organization must establish a mechanism to ensure health care professionals have access to appropriately trained and licensed clinical personnel who have access to physicians for consultation, designated by the plan to make such determinations for prior authorization concerning urgent care services.
(Source: P.A. 102-409, eff. 1-1-22.) |