{"data":{"id":"us-oh/ohio-rev.-code-1751.79","jurisdiction":"us-oh","citation":"Ohio Rev. Code § 1751.79","heading":"Utilization review program requirements.","body":"A health insuring corporation that conducts utilization review shall prepare a written utilization review program that describes all review activities, both delegated and nondelegated, for covered health care services provided, including the following:\n(A) Procedures to evaluate the clinical necessity, appropriateness, efficacy, or efficiency of health care services;\n(B) The use of data sources and clinical review criteria in making decisions;\n(C) Mechanisms to ensure consistent application of criteria and compatible decisions;\n(D) Data collection processes and analytical methods used in assessing utilization of health care services;\n(E) Mechanisms for assuring confidentiality of clinical and proprietary information;\n(F) The periodic assessment of utilization review activities, and the reporting of these assessments to the health insuring corporation's board, by a utilization review committee, a quality assurance committee, or any similar committee;\n(G) The functional responsibility for day-to-day program management by staff;\n(H) Defined methods by which guidelines are approved and communicated to providers and health care facilities.","path":["Title 17 Corporations-Partnerships","Chapter 1751 Health Insuring Corporation Law"],"source_url":"https://codes.ohio.gov/ohio-revised-code/section-1751.79","current_through":"1998-10-01 (House Bill 361 - 122nd General Assembly)","vintage":"","retrieved_at":"2026-09-14T19:24:30Z","sha256":"a6f0d489cab70c33ed5e75f53c4624d5ba7f7e42034793eeebda20e3bc86c24a","source_id":"us-oh","stale":false,"prev":"us-oh/ohio-rev.-code-1751.78","next":"us-oh/ohio-rev.-code-1751.80"},"notice":"GroundRules: Original legal text. Not legal advice."}