Oregon Administrative Rules
Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION
Division 53 - HEALTH BENEFIT PLANS
Section 836-053-1350 - Ongoing Requirements for Independent Review Organizations

Universal Citation: OR Admin Rules 836-053-1350

Current through Register Vol. 63, No. 9, September 1, 2024

(1) An independent review organization shall file an annual statistical report with the Director of the Department of Consumer and Business Services, on a form specified by the director, that summarizes reviews conducted. The report shall include, but need not be limited to, volumes, types of cases, compliance with timelines for expedited and non-expedited cases, determinations, number and nature of complaints and compliance with conflict of interests rules.

(2) An independent review organization shall submit updated information to the director if at any time there is a material change in the information included in the response of the independent review organization to the director's request for proposals.

(3) An independent review organization shall maintain records of all materials, including materials submitted by all parties, notifications, documents relied upon, and the independent review organization's ultimate decision for a period of not less than three years after any review. The independent review organization shall provide copies of any of these documents to the director upon request.

Statutory/Other Authority: ORS 731.244, ORS 743B.252, ORS 743B.253 & ORS 743B.256

Statutes/Other Implemented: ORS 743B.253 & ORS 743B.256

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