Georgia Directive 21-EX-1
reissued Directive 20-EX-11
, which advises (1) insurers authorized to write accident and health insurance in this state, health maintenance organizations, municipal cooperative health benefit plans, and prepaid health services plans (collectively, the “Issuers”
); (2) independent agents performing utilization review under contract with such Issuers; and (3) licensed independent adjusters, to suspend the following utilization review and notification requirements:
1. Suspension of Preauthorization Requirements.
Issuers are generally permitted to require preauthorization for health care services, other than emergency services. However, Issuers are now advised to suspend preauthorization review for scheduled surgeries or admissions at hospitals due to a lack of resources in hospitals.
2. Suspension of Concurrent Review for Inpatient Hospital Services.
Issuers are generally permitted to review services concurrently for medical necessity and to make determinations involving continued or extended health care services or additional services for an insured undergoing a course of continued treatment prescribed by a health care provider within one business day of receipt of the necessary information. However, Issuers are now advised to suspend concurrent review for inpatient hospital services due to a lack of resources in hospitals.
3. Applicability to Third-Party Administrators of Self-Funded Plans.
Third-party administrators, which are licensed by the Department of Insurance as independent adjusters, are strongly encouraged to apply the above provisions to their administrative services arrangements with self-funded plans.