D.C. Mun. Regs. tit. 26, r. 26-A1902
Current through Register 71, No. 45, November 7, 2024
If an insurer has specific questions concerning the diagnosis or treatment given or, prescribed, by a physician, psychologist, or social worker, the insurer may request that the health professional undergo peer review as a condition of approving payment or reimbursement.
Peer review shall be conducted by an appropriate committee of physicians, psychologists, or social workers as applicable under the Act.
The insurer shall give substantial weight to the decision of any peer review committee, but shall not be bound by its determination.
If initiation of peer review is requested by the insurer the request shall not be made to circumvent the Act or prolong payment or reimbursement of a claim.
D.C. Mun. Regs. tit. 26, r. 26-A1902