Kansas Administrative Regulations

Agency 40. Insurance Department

Article 4. Accident and Health Insurance

40-4-42f External review reporting requirements.

(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.

(Authorized by K.S.A. 40-103 and L. 1999, Ch. 162, § 9; implementing L. 1999, Ch. 162, § § 6-9; effective Jan. 7, 2000.)