C.R.S. § 10-16-113.5
Independent external review of adverse determinations
Redline — December 22, 2020 → current.View current text →
Current — June 23, 2021
As of December 22, 2020
(I) The independent external review entity shall ensure that cases are reviewed by expert reviewers knowledgeable about the recommended treatment or service through the expert reviewers' actual, current clinical experience and who have appropriate expertise in the same or similar specialties as would typically manage the case being reviewed.
(II) The independent external review entity shall ensure that the decision is based upon a case review that includes a review of the medical records of the individual requesting an independent external review and a review of relevant medical and scientific evidence.
(III) The independent external review entity shall have a quality assurance procedure that ensures the timeliness and quality of the reviews conducted pursuant to this section, the qualifications and independence of the expert reviewers, and the confidentiality of medical records and review materials.
(IV) The independent external review entity shall maintain patient confidentiality pursuant to Colorado and federal law.
Independent external review of adverse determinations - legislative declaration - definitions - rules
Digitized from: Public.Law — Colorado Revised Statutes. Reproduced from public-domain Colorado statutes; confirm against the official source for the current text. Not legal advice.