(a) The commissioner shall approve external review organizations eligible to conduct external reviews under this chapter.
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Terms Used In Tennessee Code 56-61-120

  • Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-61-102
  • External review organization: means an entity that conducts independent external reviews of adverse determinations and final adverse determinations of a health carrier. See Tennessee Code 56-61-102
(b) In order to be eligible for approval by the commissioner to conduct external reviews under this chapter, an external review organization:

(1) Except as otherwise provided in this section, shall be accredited by a nationally recognized private accrediting entity that the commissioner has determined has external review organization accreditation standards that are equivalent to or exceed the minimum qualifications for external review organizations established under § 56-61-121; and
(2) Shall submit an application for approval in accordance with subsection (d).
(c) The commissioner shall develop an application form for initially approving and for reapproving external review organizations to conduct external reviews.
(d) Any external review organization wishing to be approved to conduct external reviews under this chapter shall submit the application form and include with the form all documentation and information necessary for the commissioner to determine if the external review organization satisfies the minimum qualifications established under § 56-61-121.
(e) Subject to subsection (b), an external review organization is eligible for approval under this section only if it is accredited by a nationally recognized private accrediting entity that the commissioner has determined has external review organization accreditation standards that are equivalent to or exceed the minimum qualifications for external review organizations under § 56-61-121.
(f) The commissioner may approve external review organizations that are not accredited by a nationally recognized private accrediting entity if there are no acceptable nationally recognized private accrediting entities providing external review organization accreditation.
(g) The commissioner may charge an application fee that external review organizations shall submit to the commissioner with an application for approval and reapproval.
(h) An approval is effective for two (2) years, unless the commissioner determines before its expiration that the external review organization is not satisfying the minimum qualifications established under § 56-61-121. Whenever the commissioner determines that an external review organization has lost its accreditation or no longer satisfies the minimum requirements established under § 56-61-121, the commissioner shall terminate the approval of the external review organization and remove the external review organization from the list of external review organizations approved to conduct external reviews under this chapter that is maintained by the commissioner pursuant to subsection (i).
(i) The commissioner shall maintain and periodically update a list of approved external review organizations.
(j) The commissioner may promulgate rules and regulations to carry out this section.
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