58-50-90. External review reporting requirements.
(a) An organization assigned under G.S. 58-50-80 or G.S. 58-50-82 to conduct an external review shall maintain written records in the aggregate and by insurer on all requests for external review for which it conducted an external review during a calendar year and submit a report to the Commissioner, as required under subsection (b) of this section.
(b) Each organization required to maintain written records on all requests for external review under subsection (a) of this section for which it was assigned to conduct an external review shall submit to the Commissioner, upon the Commissioner's request, a report in the format specified by the Commissioner.
(c) The report shall include in the aggregate and for each insurer:
(1) The total number of requests for external review.
(2) The number of requests for external review resolved and, of those resolved, the number resolved upholding the noncertification appeal decision or second-level grievance review decision and the number resolved reversing the noncertification appeal decision or second-level grievance review decision.
(3) The average length of time for resolution.
(4) A summary of the types of coverages or cases for which an external review was sought, as provided in the format required by the Commissioner.
(5) The number of external reviews under G.S. 58-50-80 that were terminated as the result of a reconsideration by the insurer of its noncertification appeal decision or second-level grievance review decision after the receipt of additional information from the covered person.
(6) Any other information the Commissioner may request or require.
(d) The organization shall retain the written records required under this section for at least three years.
(e) Each insurer shall maintain written records in the aggregate and for each type of health benefit plan offered by the insurer on all requests for external review of which the insurer receives notice from the Commissioner under this Part. The insurer shall retain the written records required under this section for at least three years. (2001-446, s. 4.5; 2009-382, s. 32.)
Structure North Carolina General Statutes
North Carolina General Statutes
Article 50 - General Accident and Health Insurance Regulations.
§ 58-50-1 - Waiver by insurer.
§ 58-50-15 - Conforming to statute.
§ 58-50-25 - Nurses' services.
§ 58-50-26 - Physician services provided by physician assistants.
§ 58-50-30 - Right to choose services of certain providers.
§ 58-50-35 - Notice of nonpayment of premium required before forfeiture.
§ 58-50-45 - Group health or life insurers to notify insurance fiduciaries of obligations.
§ 58-50-46 - Recodified as G.S108A-55.4 by Session Laws 2006-221, s9(a), effective January 1, 2007.
§ 58-50-56 - Insurers, preferred provider organizations, and preferred provider benefit plans.
§ 58-50-56.1 - Exclusive provider organizations, exclusive provider benefit plans.
§ 58-50-56.2 - Exclusive provider organization continuity of care.
§ 58-50-57 - Offsets against provider reimbursement for workers' compensation payments forbidden.
§ 58-50-61 - Utilization review.
§ 58-50-62 - Insurer grievance procedures.
§ 58-50-63 - Expired pursuant to Session Laws 2005-453, s3, effective July 1, 2005.
§ 58-50-65 - Certain policies of insurance not affected.
§ 58-50-70 - Punishment for violation.
§ 58-50-75 - Purpose, scope, and definitions.
§ 58-50-77 - Notice of right to external review.
§ 58-50-79 - Exhaustion of internal grievance process.
§ 58-50-80 - Standard external review.
§ 58-50-82 - Expedited external review.
§ 58-50-84 - Binding nature of external review decision.
§ 58-50-85 - Approval of independent review organizations.
§ 58-50-87 - Minimum qualifications for independent review organizations.
§ 58-50-89 - Hold harmless for Commissioner and independent review organizations.
§ 58-50-90 - External review reporting requirements.
§ 58-50-92 - Funding of external review.
§ 58-50-93 - Disclosure requirements.
§ 58-50-94 - Selection of independent review organizations.
§ 58-50-100 - Title and reference.
§ 58-50-105 - Purpose and intent.
§ 58-50-112 - Affiliated companies; HMOs.
§ 58-50-115 - Health benefit plans subject to Act.
§ 58-50-125 - Health care plans; formation; approval; offerings.
§ 58-50-130 - Required health care plan provisions.
§ 58-50-131 - Premium rates for health benefit plans; approval authority; hearing.
§ 58-50-149 - Limit on cessions to the Reinsurance Pool.
§ 58-50-150 - North Carolina Small Employer Health Reinsurance Pool.
§ 58-50-275 - Notice contact provisions.
§ 58-50-280 - Contract amendments.
§ 58-50-285 - Policies and procedures.
§ 58-50-292 - Dental provider networks; confidential business information.
§ 58-50-295 - Prohibited contract provisions related to reimbursement rates.