Ohio § 3922.15

§ 3922.15.

All clinical reviewers assigned by an independent review organization to conduct external

reviews shall have the same license as the health care provider of the service in

question, and shall be physicians or other appropriate health care providers who meet

all of the following minimum qualifications: (A) Be an expert in the treatment of the medical condition that is the subject of the

external review; (B) Be knowledgeable about the requested health care service through clinical experience,

within the last three years, treating patients with the same, or a similar, medical

condition, and, in the case of an external review of an experimental or investigational

health care service, be an expert, through clinical experience in the last three years,

in the treatment of the covered person's condition and have knowledge of the requested

health care service; (C) Hold a nonrestricted license in a state of the United States and, for physicians,

a current certification by a recognized American medical specialty board in the area

or areas appropriate to the subject of the external review; (D) Have no history of disciplinary actions or sanctions, including loss of staff privileges

or participation restrictions, that have been taken or are pending by any hospital,

governmental agency or unit, or regulatory body that raise a question as to the clinical

reviewer's physical, mental, or professional competence or moral character.