(1) An independent review organization assigned pursuant to sections 3922.08, 3922.09, or 3922.10 of the Revised Code to conduct an external review shall maintain written records in accordance with the associated rules established by the superintendent, in the aggregate by state, and by the health plan issuer, on all external reviews requested and conducted during a calendar year.
Each independent review organization shall submit this information to the superintendent, upon request, in a report in the format specified by the superintendent that shall include, in the aggregate by state and for each health plan issuer, all of the following:
(a) The total number of requests for external review;
(b) The number of requests for external review resolved and, of those resolved, the number upholding and the number reversing an adverse benefit determination;
(c) The average length of time for a resolution;
(d) A summary of the types of requested health care services or cases for which an external review was sought;
(e) The number of external reviews that were terminated as the result of a reconsideration by the health plan issuer of an adverse benefit determination after the receipt of additional information from the covered person under section 3922.05 of the Revised Code;
(f) The costs associated with external reviews, including the amounts charged by the independent review organization to conduct the reviews;
(g) The medical specialty, or the type, of clinical reviewer used to conduct each external review, as related to the specific medical condition of the covered person;
(h) Any other information the superintendent may request or require.
(2) The independent review organization shall retain the written records required under division (A)(1) of this section for at least three years.
(B) A health plan issuer shall maintain written records on all requests made for an external review under this chapter and shall provide all such information as required by any associated rules, policies, or procedures adopted by the superintendent of insurance. A health plan issuer shall maintain written records on all requests for external review for at least three years.
(C) The superintendent shall compile and annually publish the information collected under this section and report the information to the governor, the speaker and minority leader of the house of representatives, the president and minority leader of the senate, and the chairs and ranking minority members of the house and senate committees with jurisdiction over health and insurance issues.
Added by 129th General AssemblyFile No.48,HB 218, §1, eff. 12/26/2011.