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2011 Ohio Revised Code
Title [39] XXXIX INSURANCE
Chapter 3922: ADVERSE BENEFIT DETERMINATIONS
3922.15 [Effective12/26/2011] Qualifications for clinical reviewers.


OH Rev Code § 3922.15 What's This?

All clinical reviewers assigned by an independent review organization to conduct external reviews shall have the same license as the health care provider of the service in question, and shall be physicians or other appropriate health care providers who meet all of the following minimum qualifications:

(A) Be an expert in the treatment of the medical condition that is the subject of the external review;

(B) Be knowledgeable about the requested health care service through clinical experience, within the last three years, treating patients with the same, or a similar, medical condition;

(C) Hold a nonrestricted license in a state of the United States and, for physicians, a current certification by a recognized American medical specialty board in the area or areas appropriate to the subject of the external review;

(D) Have no history of disciplinary actions or sanctions, including loss of staff privileges or participation restrictions, that have been taken or are pending by any hospital, governmental agency or unit, or regulatory body that raise a question as to the clinical reviewer’s physical, mental, or professional competence or moral character.

Added by 129th General Assembly File No. 48, HB 218, § 1, eff. 12/26/2011.

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