Oklahoma § 36-6475.12

§ 36-6475.12.

Approval of independent review organizations.

Oklahoma Statutes - Title 36. Insurance

A. The Insurance Commissioner shall approve independent review

organizations eligible to be assigned to conduct external reviews

under the Uniform Health Carrier External Review Act.

B. In order to be eligible for approval by the Commissioner

under this section to conduct external reviews under the Uniform

Health Carrier External Review Act an independent review

organization:

1. Except as otherwise provided in this section, shall be

accredited by a nationally recognized private accrediting entity

that the Commissioner has determined has independent review

organization accreditation standards that are equivalent to or

exceed the minimum qualifications for independent review

organizations established under Section 6475.13 of this title; and

2. Shall submit an application for approval in accordance with

subsection D of this section.

C. The Commissioner shall develop an application form by rule

for initially approving and for reapproving independent review

organizations to conduct external reviews.

D. 1. Any independent review organization wishing to be

approved to conduct external reviews under this act shall submit the

application form and include with the form all documentation and

information necessary for the Commissioner to determine if the

independent review organization satisfies the minimum qualifications

established under Section 6475.13 of this title.

2.

a.

Subject to subparagraph b of this paragraph, an

independent review organization is eligible for

approval under this section only if it is accredited

by a nationally recognized private accrediting entity

that the Commissioner has determined has independent

review organization accreditation standards that are

equivalent to or exceed the minimum qualifications for

independent review organizations under Section 6475.13

of this title.

b.

The Commissioner may approve independent review

organizations that are not accredited by a nationally

recognized private accrediting entity if there are no

acceptable nationally recognized private accrediting

entities providing independent review organization

accreditation.

3. The Commissioner may charge an application fee that

independent review organizations shall submit to the Commissioner

with an application for approval and reapproval.

E. 1. An approval is effective for two (2) years, unless the

Commissioner determines before its expiration that the independent

review organization is not satisfying the minimum qualifications

established under Section 6475.14 of this title.

Oklahoma Statutes - Title 36. Insurance

2. Whenever the Commissioner determines that an independent

review organization has lost its accreditation or no longer

satisfies the minimum requirements established under Section 6475.14

of this title, the Commissioner shall terminate the approval of the

independent review organization and remove the independent review

organization from the list of independent review organizations

approved to conduct external reviews under the Uniform Health

Carrier External Review Act that is maintained by the Commissioner

pursuant to subsection F of this section.

F. The Commissioner shall maintain and periodically update a

list of approved independent review organizations.

G. The Commissioner may promulgate rules to carry out the

provisions of this section.

Added by Laws 2011, c. 278, § 46. Amended by Laws 2011, c. 360, §

36; Laws 2022, c. 154, § 18, eff. Nov. 1, 2022.