§ 44-1315 — Records; report; contents

(1)(a) An independent
review organization assigned pursuant to section 44-1308 , 44-1309 , or 44-1310
to conduct an external review shall maintain written records in the aggregate
by state and by health carrier on all requests for external review for which
it conducted an external review during a calendar year and, upon request,
submit a report to the director as required under subdivision (1)(b) of this
section.
(b) Each independent
review organization required to maintain written records on all requests for
external review pursuant to subdivision (1)(a) of this section for which it
was assigned to conduct an external review shall submit to the director, upon
request, a report in the format specified by the director.
(c) The report shall
include in the aggregate by state, and for each health carrier:
(i) The total number
of requests for external review;
(ii) The number of requests for external review resolved
and, of those resolved, the number resolved upholding the adverse determination
or final adverse determination and the number resolved reversing the adverse
determination or final adverse determination;
(iii) The average length of time
for resolution;
(iv)
A summary of the types of coverages or cases for which an external review
was sought, as provided in the format required by the director;
(v) The number of external
reviews pursuant to section 44-1308 that were terminated as the result of
a reconsideration 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; and
(vi) Any other information
the director may request or require.
(d) The independent review organization shall retain
the written records required pursuant to this subsection for at least three
years.
(2)(a)
Each health carrier shall maintain written records in the aggregate, by state
and for each type of health benefit plan offered by the health carrier, on
all requests for external review that the health carrier receives notice of
from the director pursuant to the Health Carrier External Review Act.
(b) Each health carrier
required to maintain written records on all requests for external review pursuant
to subdivision (2)(a) of this section shall submit to the director, upon request,
a report in the format specified by the director.
(c) The report shall include in
the aggregate, by state, and by type of health benefit plan:
(i) The total number
of requests for external review;
(ii) From the total number of requests for external
review reported under subdivision (2)(c)(i) of this section, the number of
requests determined eligible for a full external review; and
(iii) Any other information
the director may request or require.
(d) The health carrier shall retain the written records
required pursuant to this section for at least three years.

Legislative History

Source: Laws 2013, LB147, § 15.