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.
Authority: T.C.A. § 50-6-415. Administrative History: New rule filed July 1, 2022; effective September 29, 2022.