Oklahoma § 36-6475.15 - Written records

§ 36-6475.15. Written records

A. 1. An independent review organization assigned pursuant to

Section 6475.8, 6475.9, or 6475.10 of this title to conduct an

external review shall maintain written records in the aggregate by

state and by health carrier on all requests for external review for

which it conducted an external review during a calendar year and,

upon request, submit a report to the Insurance Commissioner, as

required under paragraph 2 of this subsection.

2. Each independent review organization required to maintain

written records on all requests for external review pursuant to

paragraph 1 of this subsection for which it was assigned to conduct

an external review shall submit to the Commissioner, upon request, a

report in the format specified by the Commissioner.

3. The report shall include in the aggregate by state, and for

each health carrier:

a.

the total number of requests for external review,

b.

the number of requests for external review resolved

and, of those resolved, the number resolved upholding

the adverse determination or final adverse

determination and the number resolved reversing the

adverse determination or final adverse determination,

c.

the average length of time for resolution,

Oklahoma Statutes - Title 36. Insurance

d.

a summary of the types of coverages or cases for which

an external review was sought, as provided in the

format required by the Commissioner,

e.

the number of external reviews pursuant to subsection

G of Section 6475.8 of this title that were terminated

as the result of a reconsideration by the health

carrier of its adverse determination or final adverse

determination after the receipt of additional

information from the covered person or the covered

person's authorized representative, and

f.

any other information the Commissioner may request or

require.

4. The independent review organization shall retain the written

records required pursuant to this subsection for at least three (3)

years.

B. 1. Each health carrier shall maintain written records in

the aggregate, by state and for each type of health benefit plan

offered by the health carrier on all requests for external review

that the health carrier receives notice of from the Commissioner

pursuant to this act.

2. Each health carrier required to maintain written records on

all requests for external review pursuant to paragraph 1 of this

subsection shall submit to the Commissioner, upon request, a report

in the format specified by the Commissioner.

3. The report shall include in the aggregate, by state, and by

type of health benefit plan:

a.

the total number of requests for external review,

b.

from the total number of requests for external review

reported under subparagraph a of this paragraph, the

number of requests determined eligible for a full

external review, and

c.

any other information the Commissioner may request or

require.

4. The health carrier shall retain the written records required

pursuant to this subsection for at least three (3) years.

Added by Laws 2011, c. 278, § 49. Amended by Laws 2011, c. 360, §

39; Laws 2022, c. 154, § 19, eff. Nov. 1, 2022.