| (H) the patient was otherwise ineligible for the dental
care service under the patient's employee benefit plan or health insurance
policy and the plan or policy issuer did not know, and could not reasonably
have known, that the patient was ineligible for the dental care service
on the date the prior authorization was issued.
(l) If a health benefit plan issuer subject to Insurance
Code Chapter 1222 requires preauthorization as a condition of payment
for a medical or health care service, the heath benefit plan issuer
must provide a preauthorization renewal process that allows a physician
or health care provider to request renewal of an existing preauthorization
at least 60 days before the date the preauthorization expires. When
practicable, a URA must review and issue a determination on a renewal
request before the existing preauthorization expires if the URA receives
the request before the existing preauthorization expires. The determination
must indicate whether the medical or health care service is preauthorized.
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