3901.81 Utilizing services of clinical peers. - Ohio Statutes

3901.81 Utilizing services of clinical peers.

An independent review organization selected under section 3901.80 of the Revised Code to conduct an external review under section 1751.84, 3923.67, or 3923.76 of the Revised Code shall utilize the services of clinical peers who have expertise in the treatment of the medical condition of the enrollee, insured, or plan member and clinical experience in the past three years with the service requested or recommended by the enrollee, insured, or plan member or the provider of the enrollee, insured, or plan member. The review shall be conducted by a single clinical peer, unless the health insuring corporation, insurer, or public employee benefit plan determines that more than one clinical peer is needed. The clinical peer must hold a license that is not restricted in any manner by the state in which the clinical peer is licensed. The clinical peer shall not have been disciplined or sanctioned by a hospital or government entity based on the quality of care provided by the clinical peer. In the case of a physician, the clinical peer must be certified by a nationally recognized medical specialty board in the area that is the subject of the review.

Effective Date: 05-01-2000