Or. Admin. Code § 836-053-1360

Current through Register Vol. 63, No. 12, December 1, 2024

Section 836-053-1360 - External Review Reporting

(1) Each independent review organization shall maintain written records in the aggregate and by insurer on all requests for external review for which it conducted an external review for the Director of the Department of Consumer and Business Services during a calendar year.

(2) Each independent review organization shall submit to the director, by March 31 of each year for the preceding calendar year, a report in the format specified by the director. The report shall include the information required by this section in the aggregate, for each insurer, for Oregon external reviews only. The information to be included in the report as provided in this section is as follows:

(a) The total number of requests for external review received during the reporting period;

(b) The number of requests for external review for which the independent review organization has made a final decision and, of those requests, the number that uphold the insurer's final adverse determination;

(c) The average length of time for final decision by the independent review organization of:

(A) Disputes other than expedited disputes; and

(B) Expedited disputes.

(d) A summary of the types of coverages or cases for which an external review was sought;

(e) The number of requests for which the independent review organization decided that it did not have jurisdiction under ORS 743B.252.

(f) The number of external review cases that were terminated as the result of a reconsideration by the insurer of the insurer's final adverse determination after the receipt of additional information from the enrollee or the enrollee's designated representative; and

(g) Any other information the director requests or requires.

Or. Admin. Code § 836-053-1360

ID 10-2002(Temp), f. & cert. ef. 4-5-02 thru 9-27-02; ID 19-2002, f. 9-27-02, cert. ef. 9-28-02; ID 12-2013, f. 12-31-13, cert. ef. 1-1-14; ID 28-2018, minor correction filed 08/22/2018, effective 8/22/2018

Statutory/Other Authority: ORS 731.244, ORS 743B.253 & ORS 743B.256

Statutes/Other Implemented: ORS 743B.253 & ORS 743B.256