Mo. Rev. Stat. §§ 376.1350 through 376.1389: Health Care Utilization Review – Missouri

Status: Enacted
Year Enacted: 1997
Year Amended: 2018
File: Download

A utilization review program shall use documented clinical review criteria that are based on sound clinical evidence and are evaluated periodically to assure ongoing efficacy. A health carrier may develop its own clinical review criteria, or it may purchase or license clinical review criteria from qualified vendors. A health carrier shall make available its clinical review criteria upon request by either the director of the department of health and senior services or the director of the department of insurance, financial institutions and professional registration.


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