§ 23-17.12-4 - Application process.
SECTION 23-17.12-4
§ 23-17.12-4 Application process. –(a) An applicant requesting certification or recertification shall:
(1) Submit an application provided by the director; and
(2) Pay the application fee established by the directorthrough regulation and § 23-17.12-3(f).
(b) The application shall:
(1) Be on a form and accompanied by supporting documentationthat the director requires; and
(2) Be signed and verified by the applicant.
(c) Before the certificate expires, a certificate may berenewed for an additional two (2) years.
(d) If a completed application for recertification is beingprocessed by the department, a certificate may be continued until a renewaldetermination is made.
(e) In conjunction with the application, the review agentshall submit information that the director requires including:
(1) A request that the state agency regard specific portionsof the standards and criteria or the entire document to constitute "tradesecrets" within the meaning of that term in § 38-2-2(4)(i)(B);
(2) The policies and procedures to ensure that all applicablestate and federal laws to protect the confidentiality of individual medicalrecords are followed;
(3) A copy of the materials used to inform enrollees of therequirements under the health benefit plan for seeking utilization review orpre-certification and their rights under this chapter, including information onappealing adverse determinations;
(4) A copy of the materials designed to inform applicablepatients and providers of the requirements of the utilization review plan;
(5) A list of the third party payors and business entitiesfor which the review agent is performing utilization review in this state and abrief description of the services it is providing for each client; and
(6) Evidence of liability insurance or of assets sufficientto cover potential liability.
(f) The information provided must demonstrate that the reviewagent will comply with the regulations adopted by the director under thischapter.