3901.82 Annual report of independent review organization. - Ohio Statutes

3901.82 Annual report of independent review organization.

(A) Each independent review organization that conducts external reviews under section 1751.84, 1751.85, 3923.67, 3923.68, 3923.76, or 3923.77 of the Revised Code shall annually report the following information to the superintendent of insurance in a format prescribed by the superintendent:

(1) The number of reviews conducted;

(2) The number of reviews decided in favor of enrollees, insureds, and plan members and the number decided in favor of health insuring corporations, insurers, and public employee benefit plans;

(3) The average time required to conduct a review;

(4) The number and percentage of reviews in which a decision was not reached in the time required under division (D) of section 1751.84, division (C) of section 1751.85, division (D) of section 3923.67, division (C) of section 3923.68, division (D) of section 3923.76, or division (C) of section 3923.77 of the Revised Code;

(5) A summary of the diagnoses, drugs, devices, services, procedures, and therapies that have been the subject of external review;

(6) The costs associated with external reviews, including the rates charged by the independent review organization to conduct the reviews;

(7) The medical specialty or type of provider used to conduct each external review, as related to the specific medical condition of the enrollee, insured, or plan member;

(8) Any additional information required by the superintendent by rule adopted pursuant to division (C) of this section.

(B) The superintendent of insurance shall comply with applicable state and federal laws related to the confidentiality of medical records.

(C) The superintendent may, in accordance with Chapter 119. of the Revised Code, adopt rules requiring independent review organizations to provide additional information on the consideration and disposition of external reviews brought under section 1751.84, 1751.85, 3923.67, 3923.68, 3923.76, or 3923.77 of the Revised Code.

(D) The superintendent shall compile and annually publish the information collected under this section and report the information to the governor, the speaker and minority leader of the house of representatives, the president and minority leader of the senate, and the chairs and ranking minority members of the house and senate committees with jurisdiction over health and insurance issues.

Effective Date: 05-01-2000