Section Ins 2703.08 - External Review Reporting Requirements(a) An independent review organization assigned by the commissioner to conduct external reviews shall submit an annual report to the commissioner including the following information in the aggregate and separately for each health carrier: (1) The total number of requests for external review assigned by the commissioner to the independent review organization;(2) The total number of requests for external review assigned by the commissioner to the independent review organization for which a final adjudication was made, and, of those, the number resolved upholding the adverse determination or final adverse determination and the number resolved reversing the adverse determination or final adverse determination;(3) The average length of time required for the adjudication;(4) A summary of the types of coverages or cases for which an external review was sought;(5) The number of external reviews that were terminated prior to completion as the result of a reconsideration and reversal by the health carrier of its adverse determination or final adverse determination after the receipt of new or additional information from the covered person or the covered person's authorized representative;(6) The number of external reviews that were terminated prior to completion as the result of a settlement between the health carrier and the covered person on terms other than the original determination of the health carrier or a complete reversal of that determination;(7) The number of external reviews that were terminated prior to completion for other reasons; and(8) Verification that the organization maintains written records fully documenting requests for external review received from the commissioner.(b) The independent review organization shall retain all files, records and data received or created in conjunction with external reviews conducted pursuant to this rule for at least 3 years.N.H. Admin. Code § Ins 2703.08
#7539, eff 8-1-01; ss by #8862, eff 5-1-07
Amended by Volume XXXV Number 36, Filed September 10, 2015, Proposed by #10918, Effective 9/1/2015, Expires9/1/2025.