In conjunction with the application, the private review agent shall submit information that the State Board of Health requires, including:
(1) A utilization review plan that includes: A description of review standards and procedures to be used in evaluating proposed or delivered hospital and medical care; and
(2) The provisions by which patients, physicians, or hospitals may seek reconsideration or appeal of adverse decisions by the private review agent;
(3) The type and qualifications of the personnel either employed or under contract to perform the utilization review;
(4) The procedures and policies to ensure that a representative of the private review agent is reasonably accessible to patients and providers five (5) days a week during normal business hours in this state;
(5) The policies and procedures to ensure that all applicable state and federal laws to protect the confidentiality of individual medical records are followed;
(6) A copy of the materials designed to inform applicable patients and providers of the requirements of the utilization review plan; and
(7) A list of the third party payors for which the private review agent is performing utilization review in this state.