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PARRIS N. GLENDENING, Governor Ch. 123
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(2) pay to the Commissioner the application fee established by the
Commissioner through regulation.
(b) The application shall:
(1) be on a form and accompanied by any supporting documentation that
the Commissioner requires; and
(2) be signed and verified by the applicant.
(c) The application fees required under subsection (a)(2) of this section or §
15-10B-10(b)(2) of this subtitle shall be sufficient to pay for the administrative costs
of the certificate program and any other costs associated with carrying out the
provisions of this subtitle.
15-10B-05.
(a) In conjunction with the application, the private review agent shall submit
information that the Commissioner requires including:
(1) a utilization review plan that includes:
(i) the specific criteria and standards to be used in conducting
utilization review of proposed or delivered HEALTH CARE services;
(ii) those circumstances, if any, under which utilization review may
be delegated to a hospital utilization review program; and
(iii) [the] IF APPLICABLE, ANY provisions by which patients,
physicians, or hospitals may seek reconsideration [or appeal of adverse decisions by
the private review agent];
(2) the type and qualifications of the personnel either employed or under
contract to perform the utilization review;
(3) A COPY OF THE PRIVATE REVIEW AGENT'S INTERNAL GRIEVANCE
PROCESS IF A CARRIER DELEGATES ITS INTERNAL GRIEVANCE PROCESS TO THE
PRIVATE REVIEW AGENT IN ACCORDANCE WITH § 15-10A-02(L) OF THIS TITLE;
[(3)] (4) the procedures and policies to ensure that a representative of
the private review agent is reasonably accessible to patients and HEALTH CARE
providers [5] 7 days a week [during normal business], 24 hours A DAY in this State;
[(4)](5) the policies and procedures to ensure that all applicable State
and federal laws to protect the confidentiality of individual medical records are
followed;
[(5)] (6) a copy of the materials designed to inform applicable patients
and providers of the requirements of the utilization review plan;
[(6)] (7) a list of the third party payors for which the private review
agent is performing utilization review in this State;
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- 751 -
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