Review Panel

(1) Upon receipt of an external review referral the external review agency shall assign the review to a panel that is comprised of one or more clinical reviewers who did not participate in any of the carrier's prior decisions on the claim or internal grievance. These reviewers shall be actively practicing health care professionals in the same or similar specialty who typically treat the medical condition, perform the procedure or provide the treatment that is the subject of the external review. (2) Upon receipt of an external review referral involving services or treatment considered by the carrier or utilization review organization to be experimental or investigational, or other services or treatment as determined by the Office of Patient Protection, the external review agency shall assign the review to a panel that is comprised of three clinical reviewers who did not participate in any of the carrier's prior decisions on the claim or internal grievance. These reviewers shall be actively practicing health care professionals in the same or similar specialty who typically treat the medical condition, perform the procedure or provide the treatment that is the subject of the external review.