Nebraska § 44-7310 Standard review
of adverse determinations

Nebraska Statutes

§ 44-7310 — Standard review of adverse determinations

Nebraska § 44-7310

Ch. 44Insurance

This text of Nebraska § 44-7310 (Standard review of adverse determinations) is published on Counsel Stack Legal Research, covering Nebraska primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Neb. Rev. Stat. § 44-7310 (2026).

Text

(1)A health carrier shall establish written procedures for a standard review of an adverse determination. Review procedures shall be available to a covered person and to the provider acting on behalf of a covered person. For purposes of this section, covered person includes the representative of a covered person.

(2)When reasonably necessary or when requested by the provider acting on behalf of a covered person, standard reviews shall be evaluated by an appropriate clinical peer or peers in the same or similar specialty as would typically manage the case being reviewed. The clinical peer shall not have been involved in the initial adverse determination.

(3)For standard reviews the health carrier shall notify in writing both the covered person and the attending or ordering provider of th

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(1) A health carrier
shall establish written procedures for a standard review of an adverse determination.
Review procedures shall be available to a covered person and to the provider
acting on behalf of a covered person. For purposes of this section, covered
person includes the representative of a covered person.
(2) When reasonably necessary or when requested by the provider
acting on behalf of a covered person, standard reviews shall be evaluated
by an appropriate clinical peer or peers in the same or similar specialty
as would typically manage the case being reviewed. The clinical peer shall
not have been involved in the initial adverse determination.
(3) For standard reviews the health carrier shall notify in
writing both the covered person and the attending or ordering provider of
the decision within fifteen working days after the request for a review. The
written decision shall contain the provisions required in subsection (3) of
section 44-7308 .
(4) In any case in which the standard review process does
not resolve a difference of opinion between the health carrier and the covered
person or the provider acting on behalf of the covered person, the covered
person or the provider acting on behalf of the covered person may submit a
written grievance, unless the provider is prohibited from filing a grievance
by federal or other state law.