§ 58-50-94. Selection of independent review organizations. - North Carolina Statutes

§ 58‑50‑94. Selection of independent review organizations.

(a)        At least every twoyears, or more frequently if the Commissioner determines is needed to secureadequate selection of independent review organizations, the Commissioner shallprepare and publish requests for proposals from independent revieworganizations that want to be approved under G.S. 58‑50‑85. Allproposals shall be sealed. The Commissioner shall open all proposals in public.

(b)        After the publicopening, the Commissioner shall review the proposals, examining the quality ofthe services offered by the independent review organizations, the reputationand capabilities of the independent review organizations submitting theproposals, and the provisions in G.S. 58‑50‑85 and G.S. 58‑50‑87.The Commissioner shall determine which proposal or proposals would satisfy theprovisions of this Part. The Commissioner shall make his determination inconsultation with an evaluation committee whose membership includesrepresentatives of insurers subject to Part 4 of Article 50 of Chapter 58 ofthe General Statutes, health care providers, and insureds. In selecting thereview organizations, in addition to considering cost, quality, and adherenceto the requirements of the request for proposals, the Commissioner shallconsider the desirability and feasibility of contracting with multiple revieworganizations and shall ensure that, for any given type of case involvinghighly specialized services and treatments, at least one review organization isavailable and capable of reviewing the case.

(c)        An independentreview organization may seek to modify or withdraw a proposal only after thepublic opening and only on the basis that the proposal contains anunintentional clerical error as opposed to an error in judgment. An independentreview organization seeking to modify or withdraw a proposal shall submit tothe Commissioner a written request, with facts and evidence in support of itsposition, before the determination made by the Commissioner under subsection(b) of this section, but not later than two days after the public opening ofthe proposals. The Commissioner shall promptly review the request, examine thenature of the error, and determine whether to permit or deny the request.

(d)        The provisions ofArticle 3C of Chapter 143 of the General Statutes do not apply to this Part.  (2001‑446, s. 4.5;2009‑382, s. 33.)