Section 41-5909 – EXPEDITED EXTERNAL REVIEW.
41-5909. EXPEDITED EXTERNAL REVIEW. (1) A covered person may make a request for an expedited external review of a pre-service or concurrent service adverse benefit determination where the requested service meets the definition of an urgent care request and the covered person has exhausted the health carrier’s internal grievance process or is entitled to request […]
Section 41-5910 – BINDING NATURE OF EXTERNAL REVIEW DECISION.
41-5910. BINDING NATURE OF EXTERNAL REVIEW DECISION. (1) For a health care benefit plan not subject to the employee retirement income security act of 1974 (ERISA), the external review decision is final and binding on the health carrier and on the covered person. No judicial action or proceeding arising out of the external review decision […]
Section 41-5911 – APPROVAL OF INDEPENDENT REVIEW ORGANIZATIONS.
41-5911. APPROVAL OF INDEPENDENT REVIEW ORGANIZATIONS. (1) The director shall approve independent review organizations eligible to be assigned on a random basis to conduct external reviews under this chapter. (2) In order to be eligible for approval by the director under this section to conduct external reviews under this chapter an independent review organization shall: […]
Section 41-5912 – MINIMUM QUALIFICATIONS FOR INDEPENDENT REVIEW ORGANIZATIONS.
41-5912. MINIMUM QUALIFICATIONS FOR INDEPENDENT REVIEW ORGANIZATIONS. (1) To be approved to conduct external reviews, an independent review organization shall have and maintain written policies and procedures that govern all aspects of both the standard external review process and the expedited external review process set forth in this chapter that include, at a minimum: (a) […]
Section 41-5913 – HOLD HARMLESS FOR INDEPENDENT REVIEW ORGANIZATIONS.
41-5913. HOLD HARMLESS FOR INDEPENDENT REVIEW ORGANIZATIONS. No independent review organization or clinical reviewer working on behalf of an independent review organization or an employee, agent or contractor of an independent review organization shall be liable in damages or otherwise to any person for any opinions rendered or acts or omissions performed within the scope […]
Section 41-5914 – EXTERNAL REVIEW REPORTING REQUIREMENTS.
41-5914. EXTERNAL REVIEW REPORTING REQUIREMENTS. (1) An independent review organization assigned pursuant to this chapter to conduct an external review shall maintain written records in the aggregate for Idaho 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 […]
Section 41-5915 – FUNDING OF EXTERNAL REVIEW.
41-5915. FUNDING OF EXTERNAL REVIEW. The health carrier against which a request for a standard external review or an expedited external review is filed shall pay the reasonable cost of the independent review organization for conducting the external review. History: [41-5915, added 2009, ch. 87, sec. 1, p. 256; am. 2011, ch. 122, sec. 8, […]
Section 41-5916 – DISCLOSURE REQUIREMENTS.
41-5916. DISCLOSURE REQUIREMENTS. (1) Each health carrier shall include a summary description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage or other evidence of coverage it provides to covered persons. The disclosure shall be in a format prescribed by the director. (2) The description required under […]
Section 41-5901 – SHORT TITLE.
41-5901. SHORT TITLE. This chapter shall be known and may be cited as the "Idaho Health Carrier External Review Act." History: [41-5901, added 2009, ch. 87, sec. 1, p. 240.]
Section 41-5917 – SEVERABILITY.
41-5917. SEVERABILITY. The provisions of this act are hereby declared to be severable and if any provision of this act or the application of such provision to any person or circumstance is declared invalid for any reason, such declaration shall not affect the validity of the remaining portions of this act. History: [41-5917, added 2009, […]