(1)At least forty-five days before disclosing the
results of a performance program, an insurer shall give a provider written notice of
the availability of the provider's individual result, specific instructions on how the
provider can access the result, and a description of the implications to the provider.
The written notice shall describe the procedures by which the provider may request:
(a)The information required to be disclosed under subsection (2) of this
section; and
(b)An appeal of the result pursuant to subsection (3) of this section.
(2)(a) Within ten business days after receiving a request by or on behalf of a
provider, an insurer shall disclose, in a manner that is reasonably understandable
and that allows the provider to verify the data against his or her records
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(1) At least forty-five days before disclosing the
results of a performance program, an insurer shall give a provider written notice of
the availability of the provider's individual result, specific instructions on how the
provider can access the result, and a description of the implications to the provider.
The written notice shall describe the procedures by which the provider may request:
(a) The information required to be disclosed under subsection (2) of this
section; and
(b) An appeal of the result pursuant to subsection (3) of this section.
(2) (a) Within ten business days after receiving a request by or on behalf of a
provider, an insurer shall disclose, in a manner that is reasonably understandable
and that allows the provider to verify the data against his or her records, the
methodology and all data upon which a provider's performance program result was
calculated, with sufficient detail to allow the provider to determine the effect of the
methodology on the data reviewed.
(b) An insurer shall not use the Uniform Trade Secrets Act, article 74 of
title 7, C.R.S., to avoid compliance with this section.
(3) Insurers shall establish procedures for providers to appeal the results of
a performance program. Such procedures, in addition to the disclosures and the
written notice furnished, shall provide:
(a) A reasonable method by which the provider may submit notice of the
desire to appeal;
(b) The name, title, qualifications, and relationship to the insurer of any
person responsible for deciding the appeal, who shall be authorized to uphold,
modify, or reject results or require additional action to ensure that results are fair,
reasonable, accurate, and comply with the requirements of this part 6;
(c) An opportunity for a provider to submit or have considered corrected data
or other information relevant to the results or the appropriateness of the
methodology used. If requested, a provider may appear at a face-to-face meeting
with those responsible for the appeal decision at a location reasonably convenient
to the provider or by teleconference. The provider shall submit in writing any
corrected data or information in advance of the meeting.
(d) The provider's right to be assisted by a representative, including an
attorney;
(e) A detailed written decision regarding the appeal that states the reasons
for upholding, modifying, or rejecting the appeal;
(f) Resolution of the appeal within forty-five days after the date upon which
the data and methodology are disclosed unless otherwise agreed to by the parties
to the appeal; and
(g) A stay on the implementation, use, and disclosure of and action upon the
individual results of the performance program until the appeal and any subsequent
hearing requested pursuant to section 8-43-207 has become final.