Este capítulo establece las normas y los criterios que regirán la estructura y funcionamiento de los procesos de revisión de utilización y determinación de beneficios que llevan a cabo las organizaciones de seguros de salud o aseguradores. Su propósito es facilitar la continua evaluación y administración de los servicios de cuidado de la salud que reciben las personas cubiertas o asegurados.
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