Section 18.18. Independent review organization fees.

 

(1)  A certified independent review organization shall submit its fee schedule in accordance with s. 632.835 (4) (ap) , Stats., to the commissioner for review and approval.

(2)  Fee schedules shall be based on prevailing rates in the industry demonstrated by supporting credible documentation including actual costs for conducting the reviews. Fee schedules shall be on a per case basis according to categories established by the commissioner. The fee schedule shall include a category for the fee payable for a review that is terminated because the insurer voluntarily reverses its decision because of information first received by the insurer after the review is requested.

(3)  An insurer offering a health benefit plan shall pay the fee submitted by the independent review organization within 30 days of receipt of a written invoice or billing record from the independent review organization.

(4)  The independent review organization may only charge the fees in accordance with the fee schedule that is approved by the commissioner.

(6)  If an independent review organization determines the matter is not within its authority to review, it may not charge for that determination.

CR 00-169 : cr. Register November 2001 No. 551 , eff. 12-1-01; CR 10-023 : r. (5), am. (6) Register September 2010 No. 657 , eff. 10-1-10.