Colorado § 10-16-112 - Private utilization review - health-care coverage entity responsibility - definitions.
Full text of Colorado Colorado Revised Statutes § 10-16-112 — Private utilization review - health-care coverage entity responsibility - definitions., with citation guidance and answers to common questions.
§ 10-16-112. Private utilization review - health-care coverage entity responsibility - definitions.
(1) As used in this section, unless the context otherwise requires:
(a) "Private utilization review organization" means an entity, other than a hospital or public reviewer following federal guidelines, that conducts utilization review or reviews and makes determinations on prior authorization requests for health-care services as described in section 10-16-112.5. This definition shall not apply to any independent medical examination provided for in any policy of insurance.
(b) "Utilization review" means an evaluation of the necessity, appropriateness, and efficiency of the use of health-care services, procedures, and facilities, but does not include any independent medical examination provided for in any policy of insurance.
(2) Any private utilization review organization providing services to an insurance carrier, nonprofit hospital and health-care service corporation, or health maintenance organization regulated pursuant to the provisions of this article is the direct representative of the insurance carrier, nonprofit hospital and health-care service corporation, or health maintenance organization. Any insurance carrier, nonprofit hospital and health-care service corporation, or health maintenance organization is responsible for the actions of any private utilization review organization acting within the scope of any contract and on its behalf within the scope of any contract which result in any violation of this title or any rules or regulations promulgated by the commissioner.
Source: L. 93: Entire section added, p. 494, § 2, effective April 26. L. 2019: (1)(a) amended, (HB 19-1211), ch. 165, p. 1910, § 3, effective August 2.
Cross references: For the legislative declaration in HB 19-1211, see section 1 of chapter 165, Session Laws of Colorado 2019.
Source: official Colorado text · Last verified 2026-08-27
Frequently Asked Questions About Colorado § 10-16-112
What does Colorado Revised Statutes § 10-16-112 cover?
Section 10-16-112 ("Private utilization review - health-care coverage entity responsibility - definitions.") is part of the Colorado Revised Statutes, the codified statutory law of Colorado. It sets out the legal rule or procedure described in the text above. Statutes are amended regularly, so always verify against the official source.
How do I cite Colorado § 10-16-112?
A common citation format is "Colorado Revised Statutes § 10-16-112" (Colorado). Legal writing may require the code abbreviation, section number, and year or edition. Match the style required by your court, professor, or publisher.
Is this the official text of Colorado law?
No. This page is for research and education and may not include the most recent amendments. For official current law, check the Colorado official source linked on this page or consult a licensed Colorado attorney.
How does Colorado § 10-16-112 apply to my situation?
Statutes are interpreted in context, and application depends on your specific facts. Only a licensed attorney in Colorado can advise on how this section applies to you. Contact your state or local bar association for a referral.
Sources & Verification
Not legal advice. Verify against the official source and consult a licensed attorney in Colorado.