Effective: December 26, 2011
Latest Legislation: House Bill 218 - 129th General Assembly
The superintendent shall accredit independent review organizations as prescribed by this section.
(A) The superintendent shall develop an application form to accredit and renew accreditation of an independent review organization.
(B) An independent review organization seeking to be accredited by the superintendent, or to renew its accreditation, shall submit the application form and include with the form all documentation and information necessary for the superintendent to determine if the independent review organization satisfies the minimum qualifications established under section 3922.14 of the Revised Code.
(C)(1) Except as provided in division (C)(2) of this section, an independent review organization is eligible for accreditation by the superintendent under this section only if it is accredited by a nationally recognized private accrediting entity that the superintendent has determined has accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations under section 3922.14 of the Revised Code.
(2) The superintendent may approve independent review organizations that are not accredited by a nationally recognized private accrediting entity, if there are no acceptable nationally recognized private accrediting entities providing independent review organization accreditation.
(D) An independent review organization shall apply to renew its accreditation on an annual basis.
(E) If the superintendent determines that an independent review organization has lost its accreditation by a nationally recognized private accrediting entity or no longer satisfies the minimum requirements established under section 3922.14 of the Revised Code, the superintendent shall revoke the independent review organization's accreditation and shall remove the independent review organization from the list of independent review organizations approved to conduct external reviews.
(F) The superintendent shall maintain and periodically update a list of accredited independent review organizations.
Structure Ohio Revised Code
Chapter 3922 | External Review
Section 3922.01 | Definitions.
Section 3922.02 | Request for Review of Adverse Benefit Determination.
Section 3922.03 | Internal Appeal Processes; Review of Final Determination.
Section 3922.04 | Exhaustion of Issuer's Internal Appeal Process.
Section 3922.05 | Opportunities for External Review by Independent Review Organization.
Section 3922.06 | Reconsideration by Issuer.
Section 3922.07 | Information Considered for Review.
Section 3922.08 | Provisions Applicable to Standard Reviews; Timing;.
Section 3922.09 | Request for Expedited External Review.
Section 3922.11 | Review by Superintendent of Insurance.
Section 3922.12 | Effect of Decision.
Section 3922.13 | Accreditation of Independent Review Organizations.
Section 3922.14 | Additional Actions for Accreditation.
Section 3922.15 | Qualifications for Clinical Reviewers.
Section 3922.16 | Construction of Chapter; Limitations on Liability.
Section 3922.17 | Maintenance of Records; Reports.
Section 3922.18 | Payment of Costs.
Section 3922.19 | Disclosure of External Review Procedures.
Section 3922.20 | Admissibility of Written Decision or Medicare Reimbursement Standards.
Section 3922.21 | Confidentiality.