Notification of Assignment and Request for Information

(1) Upon the assignment of a request to an External Review Agency, the Office of Patient Protection shall notify the Patient, the Patient’s Authorized Representative if applicable, and the involved RBPO or ACO that the request has been assigned and shall identify the selected External Review Agency, and where applicable, identify that the review is being considered on an expedited basis. A copy of the Patient’s written authorization for the release of medical records and information shall be included with the notification. (2) Upon receipt of an external review assignment, the External Review Agency shall assign the review to an external reviewer who did not participate in any of the RBPO’s or ACO’s prior decisions on the denial or restriction. The external reviewers shall be Actively Practicing Health Care Professionals in the Same or Similar Specialty who typically treat the medical or behavioral health condition, perform the procedure or provide the treatment that is the subject of the external review.