External Quality Review Services
K.S.A. 40-22a13, 22a14, 22a15 and 22a16 provides that an insured, treating physician or health care provider acting on behalf of the insured may request through the Kansas Insurance Commissioner review of an adverse decision as defined in K.S.A. 40-22a13(a) by an insurer. After a preliminary review by the Kansas Insurance Commissioner as provided in K.A.R. 40-4-42b that determines that matter requesting external review is acceptable in accordance with K.A.R. 40-4-4b and K.S.A. 40-22a15 the Kansas Insurance Commissioner assigns the matter to an external review organization to conduct the review.
During calendar year 2008, there were 43 cases referred to the contracting external review organization by the Kansas Insurance Commissioner. The Insurance Commissioners office has been billed an average charge per case of $778.78 for cases reviewed during that time-frame.
The external review organization is an entity that conducts independent external reviews of adverse decision.
