Kansas Administrative Regulations
Agency 40 - INSURANCE DEPARTMENT
Article 4 - ACCIDENT AND HEALTH INSURANCE
Section 40-4-42f - External review reporting requirements
Universal Citation: KS Admin Regs 40-4-42f
Current through Register Vol. 43, No. 52, December 26, 2024
(a) An external review organization assigned pursuant to K.A.R. 40-4-42c and 40-4-42d to conduct an external review shall maintain written records in the aggregate and by health carrier on all requests for external review for which it conducted an external review during a calendar year and submit a report to the commissioner as required in paragraph (b)(1) of this regulation.
(b)
(1) Each
external review organization required to maintain written records on all
requests for external review pursuant to subsection (a) of this regulation 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.
(2) The report shall
include the following, at a minimum, in the aggregate and for each insurer:
(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 decision and number resolved reversing the adverse
decision;
(C) the average length
of time for resolution;
(D) the
number of external reviews pursuant to K.A.R. 40-4-42c(e) that were terminated
as the result of a reconsideration by the insurer of its adverse decision after
the receipt of additional information from the insured or the insured's
authorized representative; and
(E)
any other information that the commissioner may request or require.
(c) The external review organization shall retain the written records required pursuant to this regulation for at least five years after the final decision has been issued.
This regulation shall take effect on and after January 1, 2000.
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