Effective: December 26, 2011
Latest Legislation: House Bill 218 - 129th General Assembly
The health plan issuer against which a request for a standard external review or an expedited external review is filed shall pay the cost of the external review, including the cost of any external review that is required at the direction of the superintendent.
If the superintendent determines that, due to the facts and circumstances of an external review, a second external review is required, the health plan issuer shall pay the costs of the second review.
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.