Ohio Revised Code Chapter 3922 - External Review

• Section 3922.01 - Definitions.
  As used in this chapter: (A) "Adverse benefit determination" means a decision by a health plan issuer: (1) To deny, reduce, or terminate a...
• Section 3922.02 - Request For Review Of Adverse Benefit Determination.
  (A) A covered person may make a request for an external review of an adverse benefit determination. (B) All requests for external review shall...
• Section 3922.03 - Internal Appeal Processes; Review Of Final Determination.
  (A) All health plan issuers shall implement an internal appeal process under which a covered person may appeal an adverse benefit determination. This process...
• Section 3922.04 - Exhaustion Of Issuer's Internal Appeal Process.
  (A) Except as provided in division (E) of this section, a health plan issuer is not required to grant a request for a standard...
• Section 3922.05 - Opportunities For External Review By Independent Review Organization.
  (A) A health plan issuer shall afford the opportunity for an external review by an independent review organization for an adverse benefit determination if...
• Section 3922.06 - Reconsideration By Issuer.
  Except for when an expedited request is made under section 3922.09 or 3922.10 of the Revised Code, an independent review organization shall forward upon...
• Section 3922.07 - Information Considered For Review.
  In addition to the information provided under division (D)(1)(b) of section 3922.05, division (B) of section 3922.08, division (C) of section 3922.09, and division...
• Section 3922.08 - Provisions Applicable To Standard Reviews; Timing;.
  (A) The provisions of this section apply only to standard reviews, which are not expedited and do not involve an experimental or investigational treatment....
• Section 3922.09 - Request For Expedited External Review.
  (A) A covered person may make a request for an expedited external review, except as provided in division (I) of this section: (1) After...
• Section 3922.10 - Provisions Applicable To External Reviews Involving Experimental Or Investigational Treatment; Timing.
  The provisions of this section apply only to external reviews that involve an experimental or investigational treatment. (A) A covered person may request an...
• Section 3922.11 - Review By Superintendent Of Insurance.
  (A) The superintendent of insurance shall establish and maintain a system for receiving and reviewing requests for external review for adverse benefit determinations where...
• Section 3922.12 - Effect Of Decision.
  (A) An external review decision is binding on the health plan issuer except to the extent the health plan issuer has other remedies available...
• Section 3922.13 - Accreditation Of Independent Review Organizations.
  The superintendent shall accredit independent review organizations as prescribed by this section. (A) The superintendent shall develop an application form to accredit and renew...
• Section 3922.14 - Additional Actions For Accreditation.
  (A) To be accredited by the superintendent of insurance to conduct external reviews under section 3922.13 of the Revised Code, in addition to the...
• Section 3922.15 - Qualifications For Clinical Reviewers.
  All clinical reviewers assigned by an independent review organization to conduct external reviews shall have the same license as the health care provider of...
• Section 3922.16 - Construction Of Chapter; Limitations On Liability.
  (A) Nothing in this chapter shall be construed to create a cause of action against any of the following: (1) An employer that provides...
• Section 3922.17 - Maintenance Of Records; Reports.
  (A) (1) An independent review organization assigned pursuant to sections 3922.08, 3922.09, or 3922.10 of the Revised Code to conduct an external review shall...
• Section 3922.18 - Payment Of Costs.
  The health plan issuer against which a request for a standard external review or an expedited external review is filed shall pay the cost...
• Section 3922.19 - Disclosure Of External Review Procedures.
  (A) Each health plan issuer shall include a description of its external review procedures, including the superintendent's contractual review, in, or attached to, the...
• Section 3922.20 - Admissibility Of Written Decision Or Medicare Reimbursement Standards.
  Consistent with the Rules of Evidence, a written decision or opinion prepared by an independent review organization under this chapter shall be admissible in...
• Section 3922.21 - Confidentiality.
  (A) When a record containing information pertaining to the medical history, diagnosis, prognosis, or medical condition of a covered person is provided to the...
• Section 3922.22 - Adoption Of Rules.
  The superintendent may adopt rules under Chapter 119. of the Revised Code to carry out the purposes of this chapter and shall prescribe forms...
• Section 3922.23 - Violation; Penalties.
  A violation of this chapter shall be an unfair or deceptive act or practice under sections 3901.19 to 3901.26 of the Revised Code. Additionally,...

Last modified: October 10, 2016