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What happens if the insurer misses the deadline to provide information to the Department or the IRO?

April 26, 2017Deadline Department happens insurer iro misses

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What happens if the insurer misses the deadline to provide information to the Department or the IRO?

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The external review will proceed. NCGS 58-50-80(e) states: “Failure by the insurer or its designee utilization review organization to provide the documents and information within the time specified in this subsection shall not delay the conduct of the external review. However, if the insurer or its utilization review organization fails to provide the documents and information within the time specified in subdivision (b)(4) of this section, the assigned organization may terminate the external review and make a decision to reverse the noncertification appeal decision or the second-level grievance review decision. Within one business day of making the decision under this subsection, the organization shall notify the covered person, the insurer, and the Commissioner.