ARSD 20:06:53:05. Review procedures and authorization to accompany notice

In addition to the information required by § 20:06:53:04, the health carrier shall include a copy of the description of both the standard and expedited external review procedures the health carrier is required to provide pursuant to § 20:06:53:67, highlighting the provisions in the external review procedures that give the covered person or the covered person's authorized representative the opportunity to submit additional information and including any forms used to process an external review. As part of any forms provided under this section, the health carrier shall include an authorization form, or other document approved by the director that complies with the requirements of 45 C.F.R § 164.508, by which the covered person, for purposes of conducting an external review under this chapter, authorizes the health carrier and the covered person's treating health care provider to disclose protected health information, including medical records, concerning the covered person that are pertinent to the external review, as provided in § 20:06:45:27.