514J.6 - INDEPENDENT REVIEW ENTITIES.
514J.6 INDEPENDENT REVIEW ENTITIES. 1. The commissioner shall solicit names of independent review entities from carriers, organized delivery systems, and medical and health care professional associations. 2. Independent review entities include, but are not limited to, the following: a. Medical peer review organizations. b. Nationally recognized health experts or institutions. 3. The commissioner shall certify independent review entities to conduct external reviews. An individual who conducts an external review as or as part of a certified independent review entity shall be a health care professional and satisfy both of the following requirements: a. Hold a current unrestricted license to practice medicine or a health profession in the United States. A health care professional who is a physician shall also hold a current certification by a recognized American medical specialty board. A health care professional who is not a physician shall also hold a current certification by such professional's respective specialty board. b. Have no history of disciplinary actions or sanctions, including, but not limited to, the loss of staff privileges or any participation restriction taken or pending by any hospital or state or federal government regulatory agency. 4. Each independent review entity shall have a quality assurance program on file with the commissioner that ensures the timeliness and quality of the reviews, the qualifications and independence of the experts, and the confidentiality of medical records and review materials. 5. The commissioner shall certify independent review entities every two years.
Section History: Recent Form 99 Acts, ch 41, §12, 22 Referred to in § 514J.2