Missouri § 376.1372 - Certification and member handbook to include utilization review procedures — website or provider portal, prior authorization requirements available on.
Full text of Missouri Revised Statutes of Missouri § 376.1372 — Certification and member handbook to include utilization review procedures — website or provider portal, prior authorization requirements available on., with citation guidance and answers to common questions.
§ 376.1372. Certification and member handbook to include utilization review procedures — website or provider portal, prior authorization requirements available on.
1. In the certificate of coverage and the member handbook provided to enrollees, a health carrier shall include a clear and comprehensive description of its utilization review procedures, including the procedures for obtaining review of adverse determinations, and a statement of rights and responsibilities of enrollees with respect to those procedures.
2. A health carrier shall include a summary of its utilization review procedures in material intended for prospective enrollees.
3. A health carrier shall print on its membership cards a toll-free telephone number to call for utilization review decisions.
4. (1) A health carrier or utilization review entity shall make any current prior authorization requirements or restrictions, including written clinical review criteria, readily accessible on its website or provider portal. Requirements and restrictions, including step therapy protocols as such term is defined in section 376.2030, shall be described in detail.
(2) No health carrier or utilization review entity shall amend or implement a new prior authorization requirement or restriction prior to the change being reflected on the carrier or utilization review entity's website or provider portal as specified in subdivision (1) of this subsection.
(3) Health carriers and utilization review entities shall provide participating providers with written or electronic notice of the new or amended requirement not less than sixty days prior to implementing the requirement or restriction.
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(L. 1997 H.B. 335, A.L. 2019 S.B. 514)
---- end of effective 28 Aug 2019 ----
Source: official Missouri text · Last verified 2026-08-27
Frequently Asked Questions About Missouri § 376.1372
What does Revised Statutes of Missouri § 376.1372 cover?
Section 376.1372 ("Certification and member handbook to include utilization review procedures — website or provider portal, prior authorization requirements available on.") 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 § 376.1372?
A common citation format is "Revised Statutes of Missouri § 376.1372" (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 § 376.1372 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.