South Carolina Code 38-71-2030. External review; written records; reports
(2) Each independent review organization required to maintain written records on all requests for external review pursuant to item (1) for which it was assigned to conduct an external review shall submit to the director or his designee, no later than March first of each year and upon request by the director or his designee, a report in the format specified by the director or his designee.
Terms Used In South Carolina Code 38-71-2030
- Director: means the person who is appointed by the Governor upon the advice and consent of the Senate and who is responsible for the operation and management of the department. See South Carolina Code 38-1-20
- Person: means a corporation, agency, partnership, association, voluntary organization, individual, or another entity, organization, or aggregation of individuals. See South Carolina Code 38-1-20
(3) The report shall include in the aggregate and for each health carrier:
(a) the total number of requests for external review and the manner in which they were resolved;
(b) the average length of time for resolution;
(c) a summary of the types of coverages or cases for which an external review was sought, as provided in the format required by the director or his designee; and
(d) any other information the director or his designee may request or require.
(4) The independent review organization shall retain the written records required pursuant to this subsection for at least three years.
(B)(1) Each health carrier shall maintain written records in the aggregate and for each general type of health benefit plan offered by the health carrier on all requests for external review that are filed with the health carrier during a calendar year.
(2) Each health carrier required to maintain written records on all requests for external review pursuant to item (1) shall submit to the director or his designee, no later than March first of each year and upon request by the director or his designee, a report in the format specified by the director or his designee.
(3) The report shall include in the aggregate and by type of health benefit plan:
(a) the total number of requests for external review and the manner in which they were resolved;
(b) the average length of time for resolution;
(c) a summary of the types of coverages or cases for which an external review was sought, as provided in the format required by the director or his designee; and
(d) any other information the director or his designee may request or require.
(4) The health carrier shall retain the written records required pursuant to this subsection for at least three years.
(C) The director or his designee shall make the reports required in this section available to any person for inspection and copying upon request.