§ 991.2164l. External review reporting requirements
Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 40 P.S. InsuranceEffective: January 1, 2024
Effective: January 1, 2024
40 P.S. § 991.2164l
§ 991.2164l. External review reporting requirements
(1) An IRO assigned under section 21621 or this subdivision to conduct an external review shall maintain written records in the aggregate for the entire Commonwealth and for each insurer or MA or CHIP managed care plan, on all requests for which the IRO conducted an external review during a calendar year.
(ii) The number of requests for external review resolve and, of those resolved, the number resolved upholding the grievance decision, adverse benefit determination or final adverse benefit determination and the number resolved reversing the grievance decision, adverse benefit determination or final adverse benefit determination.
(v) The number of external reviews under sections 2164.52 and 2164.73 that were terminated as the result of a reconsideration by the insurer of the adverse benefit determination or final adverse benefit determination after the receipt of additional information from the covered person or the covered person's authorized representative.
Credits
1921, May 17, P.L. 682, No. 284, § 2164.12, added 2022, Nov. 3, P.L. 2068, No. 146, § 7, effective Jan. 1, 2024.
40 P.S. § 991.2164l, PA ST 40 P.S. § 991.2164l
Current through Act 10 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
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