Tenn. Comp. R. & Regs. 0800-02-06-.15 - ANNUAL REPORTS FROM UTILIZATION REVIEW VENDORS

Each year no later than March 1, utilization review organizations shall send the Bureau an annual report, as described below, for the preceding calendar year.

(1) The total number of requested utilization review organization determinations by utilization review organizations as defined in these rules;

(2) The results of the determinations categorized by denials, modifications, and approvals;

(3) The names of all utilization review physicians used by the utilization review organization during the preceding year and the number of reviews each utilization review physician performed, and if subcontracted, a list of utilization review physicians used by the subcontractor; and

(4) A record of all peer-to-peer conferences requested, the number of conferences completed, the results by number of upholds, modifications, and overturns of the completed conferences; the names of the utilization review organization physician(s) involved, and the number of conferences participated in by each utilization review physician.

(5) Failure to timely submit an annual report for a calendar year shall subject a party to a penalty of not less than fifty dollars ($50.00) nor more than five thousand dollars ($5,000.00) per violation at the discretion of the Administrator.

Notes

Tenn. Comp. R. & Regs. 0800-02-06-.15

New rule filed July 1, 2022; effective 9/29/2022.

Authority: T.C.A. § 50-6-415.