{"data":{"id":"us-il/215-ilcs-200-35","jurisdiction":"us-il","citation":"215 ILCS 200/35","heading":"Personnel qualified to make adverse determinations of a prior authorization request.","body":"A health insurance issuer or its contracted utilization review organization must ensure that all adverse determinations are made by a physician when the request is by a physician or a representative of a physician. The physician must:\n(1) possess a current and valid nonrestricted license in any United States jurisdiction; and\n(2) have experience treating and managing patients with the medical condition or disease for which the health care service is being requested.\nNotwithstanding the foregoing, a licensed health care professional who satisfies the requirements of this Section may make an adverse determination of a prior authorization request submitted by a health care professional licensed in the same profession.","path":["CHAPTER 215 INSURANCE","Prior Authorization Reform Act."],"source_url":"https://www.ilga.gov/legislation/ILCS/details?ActID=4201\u0026ChapterID=22\u0026ChapAct=FullText\u0026Print=True","current_through":"at least Public Act 104-790","vintage":"","retrieved_at":"2026-09-15T04:46:30Z","sha256":"f355622eddbc7f1ce8801ccee8e580f30e5b6499e74ae036f425334ddd1711cc","source_id":"us-il","stale":false,"prev":"us-il/215-ilcs-200-30","next":"us-il/215-ilcs-200-40"},"notice":"GroundRules: Original legal text. Not legal advice."}