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Title 210 – NEBRASKA DEPARTMENT OF INSURANCE  

Chapter 87 – HEALTH CARRIER EXTERNAL REVIEW  

001. Authority  

This regulation is adopted by the director pursuant to the authority in Neb. Rev. Stat. §§ 44-1305 (1)(c), 44-1306(1)(b), 44-1315(1)(b), 44-1315(2)(b), and 44-1317(1)(b).  

002. Purpose  

The purpose of this rule is to adopt the forms required pursuant to the Health Carrier External Review Act, Neb.Rev.Stat. §§ 44-1301 through 44-1318.  

003. Notice of Appeal Rights  

A health carrier required to provide notice pursuant to §44-1305(1) shall provide the notice in the form in Appendix A, hereby made a part of this regulation. The health carrier may provide the notice in a form substantially similar to the form in Appendix A, if the form of such notice has been reviewed and approved by the Director.  

004. External Review Request Form  

A covered person or person acting on behalf of a covered person requesting an external review pursuant to §44-1306(1)(b) shall provide the notice in the form in Appendix B, hereby made a part of this regulation. The form in Appendix B must be provided by the carrier with all final adverse benefit determinations, published on a carrier’s website, and otherwise available upon request.  

005. Independent Review Organization External Review Annual Report Form  

An independent review organization requested by the director to prepare a report regarding requests for external review under Neb. Rev. Stat. 44-1315(1) shall provide the report in the form in Appendix C, hereby made a part of this regulation. The independent review organization may provide the report in a form substantially similar to the form in Appendix C, if the form of such report has been reviewed and approved by the Director.

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