This text of Iowa § 514J.114 (External review reporting requirements) is published on Counsel Stack Legal Research, covering Iowa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
1. a. An independent review organization assigned to conduct an external review shall
maintain written records in the aggregate by state and by health carrier of all requests for
external review for which it conducted an external review during a calendar year.
b. Each independent review organization required to maintain written records pursuant
tothissectionshallsubmittothecommissioner, uponrequest, areportintheformatspecified
by the commissioner. The report shall include in the aggregate by state and by health carrier
all of the following:
(1)The total number of requests for external review assigned to the independent review
organization.
(2)The average length of time for resolution of each request for external review assigned
to the independent review organization.
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1. a. An independent review organization assigned to conduct an external review shall
maintain written records in the aggregate by state and by health carrier of all requests for
external review for which it conducted an external review during a calendar year.
b. Each independent review organization required to maintain written records pursuant
tothissectionshallsubmittothecommissioner, uponrequest, areportintheformatspecified
by the commissioner. The report shall include in the aggregate by state and by health carrier
all of the following:
(1) The total number of requests for external review assigned to the independent review
organization.
(2) The average length of time for resolution of each request for external review assigned
to the independent review organization.
(3) A summary of the types of coverages or cases for which an external review was
requested, in the format required by the commissioner by rule.
(4) Any other information required by the commissioner.
c. The independent review organization shall retain the written records for at least three
years.
2. a. Each health carrier shall maintain written records in the aggregate by state and by
type of health benefit plan offered by the health carrier of all requests for external review that
the health carrier receives notice of from the commissioner pursuant to this chapter.
b. Each health carrier required to maintain written records of requests for external review
pursuant to this subsection shall submit to the commissioner, upon request, a report in the
format specified by the commissioner. The report shall include in the aggregate by state and
by type of health benefit plan offered all of the following:
(1) The total number of requests for external review of the health carrier’s adverse
determinations and final adverse determinations.
(2) Ofthetotalnumberofrequestsforexternalreview,thenumberofrequestsdetermined
eligible for external review.
(3) The number of requests for external review resolved and, of those resolved, the
number resolved upholding the adverse determination or final adverse determination of the
19 EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS, §514J.120
health carrier and the number resolved reversing the adverse determination or final adverse
determination of the health carrier.
(4) Thenumberofexternalreviewsthatwereterminatedastheresultofareconsideration
by the health carrier of its adverse determination or final adverse determination after the
receipt of additional information from the covered person or the covered person’s authorized
representative.
(5) Any other information the commissioner may request or require.
c. The health carrier shall retain the written records for at least three years.