Section 3 AAC 28.970 - Approval of independent review organizations; registration(a) The director may assign an independent review organization to conduct an external review in this state if the independent review organization (1) has an approved registration application on file with the director;(2) has paid the independent review organization biennial registration fee under 3 AAC 31.060;(3) is currently in good standing in this state;(4) is accredited by a nationally recognized private accrediting agency that the director determines has independent review organization accreditation standards that are equivalent to, or exceed, the minimum qualifications for independent review organizations under 3 AAC 28.974; and(5) meets the minimum qualifications under 3 AAC 28.974.(b) Notwithstanding (a) of this section, the director may approve an independent review organization that is not accredited by a nationally recognized private accrediting entity if there are no acceptable nationally recognized private accrediting entities providing independent review organization accreditation.(c) The director will maintain and periodically update a list of approved independent review organizations. The director will remove an independent review organization from the list if the director determines the independent review organization no longer satisfies the requirements established under this section.(d) An independent review organization application must include (1) payment of the biennial independent review organization registration fee under 3 AAC 31.060;(2) an independent review organization application form prescribed by the director that includes the (A) name of the state in which the applicant is domiciled;(B) name of the applicant;(C) "doing business as" name of the applicant;(D) complete physical address, mailing address, electronic mail address, telephone number, and facsimile transmission number of the (i) applicant's principal place of business in the applicant's state of domicile; and(ii) applicant's principal place of business in this state;(E) electronic mail address that the applicant desires the division to utilize to communicate with the applicant;(F) Internet address of the applicant;(G) federal employer identification number of the applicant;(H) following contact information provided for use on the division's website: (ii) the contact person for inquiries on external review questions;(iv) an electronic mail address;(vi) a facsimile transmission number;(I) applicant's signed attestation and certification that(i) verifies that the information provided by the applicant is truthful and complete:(ii) acknowledges that payment of fees associated with external reviews conducted under 3 AAC 28.950 - 3 AAC 28.982 are the sole responsibility of the health care insurer whose covered person's medical condition is being reviewed;(iii) the applicant has no recourse against the division or the state to the extent that a health care insurer fails to pay fees associated with the external review process; and(iv) authorizes the director to verify applicant information with a federal, state, or local government agency, insurance company, or accrediting organization;(J) if applicable, name and mailing address of the applicant's ultimate controlling owner or holding company; in this subparagraph, "ultimate controlling owner" has the meaning given "ultimate controlling person" in 3 AAC 21.195;(3) a copy of the business license issued to the applicant by the department;(4) a list of other states in which the applicant is approved to conduct external reviews;(5) if applicable, a list of other states in which the applicant has (A) been denied approval to conduct external reviews; or(B) had approval to conduct external reviews revoked;(6) evidence of accreditation received from a nationally recognized accrediting entity the director has determined has independent review organization standards that are equivalent to, or exceed, the minimum qualifications for independent review organizations under 3 AAC 28.974;(7) a copy of the applicant's written policies and procedures that include evidence of (A) meeting the qualifications under 3 AAC 28.974(a)(1)(A) - (F); and(B) ensuring adherence to the requirements under 3 AAC 28.950 - 3 AAC 28.982 by a contractor, .subcontractor, agent, or employee affiliated with the independent review organization;(8) a list of the reviewers retained by the independent review organization, with a description of each of their areas of expertise and the types of cases each reviewer is qualified to review;(9) the name, title, electronic mail address, telephone number, and facsimile transmission number of the physician or health care professional responsible for the supervision and oversight of the independent review procedure; and(10) a description of the fees to be charged to a health care insurer by the independent review organization for external reviews.(e) The director may retain an outside expert to perform reviews of applications submitted under this section. Eff. 3/15/2018,Register 225, April 2018Authority:AS 21.06.090
AS 21.07.005