§36-6475.12. Approval of independent review organizations.
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A. The Insurance Commissioner shall approve independent review organizations eligible to be assigned to conduct external reviews under the Uniform Health Carrier External Review Act.
B. In order to be eligible for approval by the Commissioner under this section to conduct external reviews under the Uniform Health Carrier External Review Act an independent review organization:
1. Except as otherwise provided in this section, shall be accredited by a nationally recognized private accrediting entity that the Commissioner has determined has independent review organization accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations established under Section 6475.13 of this title; and
2. Shall submit an application for approval in accordance with subsection D of this section.
C. The Commissioner shall develop an application form by rule for initially approving and for reapproving independent review organizations to conduct external reviews.
D. 1. Any independent review organization wishing to be approved to conduct external reviews under this act shall submit the application form and include with the form all documentation and information necessary for the Commissioner to determine if the independent review organization satisfies the minimum qualifications established under Section 6475.13 of this title.
2. a. Subject to subparagraph b of this paragraph, an
independent review organization is eligible for
approval under this section only if it is accredited
by a nationally recognized private accrediting entity
that the Commissioner has determined has independent
review organization accreditation standards that are
equivalent to or exceed the minimum qualifications for
independent review organizations under Section 6475.13
of this title.
b. The Commissioner may approve independent review
organizations that are not accredited by a nationally
recognized private accrediting entity if there are no
acceptable nationally recognized private accrediting
entities providing independent review organization
accreditation.
3. The Commissioner may charge an application fee that independent review organizations shall submit to the Commissioner with an application for approval and reapproval.
E. 1. An approval is effective for two
(2)years, unless the Commissioner determines before its expiration that the independent review organization is not satisfying the minimum qualifications established under Section 6475.14 of this title.
2. Whenever the Commissioner determines that an independent review organization has lost its accreditation or no longer satisfies the minimum requirements established under Section 6475.14 of this title, the Commissioner shall terminate the approval of the independent review organization and remove the independent review organization from the list of independent review organizations approved to conduct external reviews under the Uniform Health Carrier External Review Act that is maintained by the Commissioner pursuant to subsection F of this section.
F. The Commissioner shall maintain and periodically update a list of approved independent review organizations.
G. The Commissioner may promulgate rules to carry out the provisions of this section. Added by Laws 2011, c. 278, § 46. Amended by Laws 2011, c. 360, § 36; Laws 2022, c. 154, § 18, eff. Nov. 1, 2022.