§ 58-50-85. Approval of independent review organizations. - North Carolina Statutes

§ 58‑50‑85. Approval of independent review organizations.

(a)        The Commissionershall approve independent review organizations eligible to be assigned toconduct external reviews under this Part to ensure that an organizationsatisfies the minimum qualifications established under G.S. 58‑50‑87.The Commissioner shall develop an application form for initially approving andfor reapproving organizations to conduct external reviews.

(b)        Any organizationwishing to be approved to conduct external reviews under this Part shall submitthe application form and include with the form all documentation andinformation necessary for the Commissioner to determine if the organizationsatisfies the minimum qualifications established under G.S. 58‑50‑87.Applicants must submit pricing information sufficient to demonstrate that ifselected, the applicant's total fee per review will not exceed commerciallyreasonable fees charged for similar services in the industry. The Commissionershall not approve any independent review organization that either fails toprovide sufficient pricing information or has fees that do not meet theguidelines established under this subsection.

(c)        In order to beeligible for approval by the Commissioner, an independent review organizationshall be accredited by a nationally recognized private accrediting entity thatthe Commissioner has determined has independent review organizationaccreditation standards that are equivalent to or exceed the minimumqualifications established under G.S. 58‑50‑87. The Commissionermay approve independent review organizations that are not accredited by anationally recognized private accrediting entity if there are no acceptablenationally recognized private accrediting entities providing independent revieworganization accreditation.

(d)        An approval iseffective for two years, unless the Commissioner determines before expirationof the approval that the independent review organization is not satisfying theminimum qualifications established under G.S. 58‑50‑87.

(e)        Whenever theCommissioner determines that an independent review organization no longersatisfies the minimum requirements established under G.S. 58‑50‑87,the Commissioner shall terminate the approval of the independent revieworganization.  (2001‑446,s. 4.5; 2009‑382, s. 31.)