Missouri § 376.1365 - Reconsideration of an adverse determination, when.
Full text of Missouri Revised Statutes of Missouri § 376.1365 — Reconsideration of an adverse determination, when., with citation guidance and answers to common questions.
§ 376.1365. Reconsideration of an adverse determination, when.
1. In a case involving an initial determination or a concurrent review determination, a health carrier shall give the provider rendering the service an opportunity to request on behalf of the enrollee a reconsideration of an adverse determination by the reviewer making the adverse determination.
2. The reconsideration shall occur within one working day of the receipt of the request and shall be conducted between the provider rendering the service and the reviewer who made the adverse determination or a clinical peer designated by the reviewer if the reviewer who made the adverse determination is not available within one working day.
3. If the reconsideration process does not resolve the difference of opinion, the adverse determination may be appealed by the enrollee or the provider on behalf of the enrollee. Reconsideration is not a prerequisite to a standard appeal or an expedited appeal of an adverse determination.
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(L. 1997 H.B. 335)
---- end of effective 28 Aug 1997 ----
Source: official Missouri text · Last verified 2026-08-27
Frequently Asked Questions About Missouri § 376.1365
What does Revised Statutes of Missouri § 376.1365 cover?
Section 376.1365 ("Reconsideration of an adverse determination, when.") is part of the Revised Statutes of Missouri, the codified statutory law of Missouri. 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 Missouri § 376.1365?
A common citation format is "Revised Statutes of Missouri § 376.1365" (Missouri). 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 Missouri law?
No. This page is for research and education and may not include the most recent amendments. For official current law, check the Missouri official source linked on this page or consult a licensed Missouri attorney.
How does Missouri § 376.1365 apply to my situation?
Statutes are interpreted in context, and application depends on your specific facts. Only a licensed attorney in Missouri 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 Missouri.