Revised External Review Consumer Guide and Application

THE STATE OF NEW HAMPSHIRE INSURANCE DEPARTMENT 21 SOUTH F RUIT STREET S UITE 14 CONCORD, NEW HAMPSHIRE 03301 Roger A. Sevigny Commissioner Alexander K. Feldvebel Deputy Commissioner BULLETIN Docket No.: INS-16-005-AB TO: All New Hampshire Licensed Health and Dental Carriers FROM: Roger A. Sevigny f!!} DATE: January 26, 2016 RE: Revised External Review Consumer Guide and Application RSA 420-J :5-a gives enrollees of fully-insured health and dental insurance plans in New Hampshire the right to independent external review when claims or requested services are denied based on the patient or treatment not meeting the carrier's requirements for medical necessity, appropriateness, health care setting, level of care or effectiveness. Pursuant to INS 2703.04, health and dental carriers are required to provide covered persons with the New Hampshire Insurance Department (NHID) "Managed Care Consumer Guide to External Appeal" and "Request for Independent External Appeal of a Health Care Decision." The NHID updated both documents in January 2016. The updated documents are available on the NHID website at https://www.nh.gov/insurance/consumers/appeals.htm. Carriers must provide the updated versions of these documents to covered persons. Questions related to this bulletin should be directed to Keith E. Nyhan, Director of Consumer Services at (603) 271-7973 ext. 265 or email at keith.nvhantu'1ins.nh.gov. T ELEPHONE 603-271-2261 • FAX 603-271-1406 • T DD ACCESS RELAY NH 1-800-735-2964 WEBSITE: www.nh.gov/insurance