210 Neb. Admin. Code, ch. 87, § 004 - External Review Request Form
A covered person or person acting on behalf of a covered person requesting an external review pursuant to § 44-1306(1)(b) shall provide the notice in the form in Appendix B, hereby made a part of this regulation. The form in Appendix B must be provided by the carrier with all final adverse benefit determinations, published on a carrier's website, and otherwise available upon request.
Notes
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