Ohio § 3922.07 Information considered for review

Ohio Statutes

§ 3922.07 — Information considered for review

Ohio § 3922.07

Title 39Insurance

Ch. 3922External Review

This text of Ohio § 3922.07 (Information considered for review) is published on Counsel Stack Legal Research, covering Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ohio Rev. Code Ann. § 3922.07 (2026).

Text

In addition to the information provided under division (D)(1)(b) of section3922.05, division (B) of section3922.08, division (C) of section3922.09, and division (D) of section3922.10of the Revised Code, an assigned independent review organization, to the extent that such documents are available and appropriate, shall consider all of the following when conducting its review:

(A)The covered person's medical records;

(B)The attending health care professional's recommendation;

(C)Consulting reports from appropriate health care professionals and other documents submitted by the health plan issuer, covered person, or covered person's treating provider;

(D)The terms of coverage under the covered person's health benefit plan to ensure that the independent review organization's dec

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In addition to the information provided under division (D)(1)(b) of section3922.05, division (B) of section3922.08, division (C) of section3922.09, and division (D) of section3922.10of the Revised Code, an assigned independent review organization, to the extent that such documents are available and appropriate, shall consider all of the following when conducting its review:

(A) The covered person's medical records;

(B) The attending health care professional's recommendation;

(C) Consulting reports from appropriate health care professionals and other documents submitted by the health plan issuer, covered person, or covered person's treating provider;

(D) The terms of coverage under the covered person's health benefit plan to ensure that the independent review organization's decision is not contrary to the terms of the plan;

(E) The most appropriate practice guidelines, including evidence-based standards, and practice guidelines developed by the federal government, and national or professional medical societies, boards, and associations;

(F) Any applicable clinical review criteria developed and used by the health plan issuer or its designated utilization review organization;

(G) The opinion of the independent review organization's clinical reviewer or reviewers after considering the other sources described in this section.