RS 46:460.85

204 words·~1 min read·/la/title-46/46-1106

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RS 46:460.85

§460.85. Independent reviewer selection panel; procedure

A. The Independent Reviewer Selection Panel is hereby created within the department. The duties of the panel shall pertain to the independent review of claims except those reviewed in accordance with R.S. 46:460.90. The panel shall consist of the secretary or his duly designated representative and the following members appointed by the secretary:

(1)Two provider representatives.

(2)Two managed care organization representatives.

B. All decisions of the panel shall be made by a majority vote. The panel shall meet at least twice per year. Panel members shall serve without compensation.

C. The panel shall:

(1)Select a chairperson.

(2)Select and identify an appropriate number of independent reviewers and determine a uniform rate of compensation per review to be paid to each reviewer.

(3)Continually review the number and outcome of requests for reconsideration and independent reviews on an aggregated basis. The panel shall not be provided any patient-identifying information for any reason.

D. The secretary shall report to the panel the name of any provider who submits ten or more requests for independent review along with the percentage of adverse determinations that are overturned.

Acts 2017, No. 349, §2; Acts 2018, No. 284, §1.