Ohio Code 3922.13 – Accreditation of independent review organizations
The superintendent shall accredit independent review organizations as prescribed by this section.
Terms Used In Ohio Code 3922.13
- Independent review organization: means an entity that is accredited to conduct independent external reviews of adverse benefit determinations pursuant to section 3922. See Ohio Code 3922.01
- Superintendent: means the superintendent of insurance. See Ohio Code 3922.01
(A) The superintendent shall develop an application form to accredit and renew accreditation of an independent review organization.
(B) An independent review organization seeking to be accredited by the superintendent, or to renew its accreditation, shall submit the application form and include with the form all documentation and information necessary for the superintendent to determine if the independent review organization satisfies the minimum qualifications established under section 3922.14 of the Revised Code.
(C)(1) Except as provided in division (C)(2) of this section, an independent review organization is eligible for accreditation by the superintendent under this section only if it is accredited by a nationally recognized private accrediting entity that the superintendent has determined has accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations under section 3922.14 of the Revised Code.
(2) The superintendent may approve independent review organizations that are not accredited by a nationally recognized private accrediting entity, if there are no acceptable nationally recognized private accrediting entities providing independent review organization accreditation.
(D) An independent review organization shall apply to renew its accreditation on an annual basis.
(E) If the superintendent determines that an independent review organization has lost its accreditation by a nationally recognized private accrediting entity or no longer satisfies the minimum requirements established under section 3922.14 of the Revised Code, the superintendent shall revoke the independent review organization’s accreditation and shall remove the independent review organization from the list of independent review organizations approved to conduct external reviews.
(F) The superintendent shall maintain and periodically update a list of accredited independent review organizations.