Common use of Standard of Review Clause in Contracts

Standard of Review. Within 1 business day after the receipt of the notice of assignment to conduct the external review, the assigned IRO will select a Clinical Peer, or multiple Clinical Peers if medically appropriate under the circumstances, to conduct the external review. The assigned IRO will select Physicians or other health care providers using the same criteria as set forth in the Standard of Review paragraph in the Standard External Review Procedures, above. The choice of the Physicians or other health care providers to conduct the external review may not be made by the Member or the Member’s authorized representative or The Plan. Each Clinical Peer selected pursuant will review and consider all of the information and documents considered by The Plan in making the adverse benefit determination or the final internal Benefit determination and any other information submitted in writing by the Member or the Member’s authorized representative. Each Clinical Peer will provide an opinion to the assigned IRO as expeditiously and the Member’s medical condition or circumstances require but no later than 5 calendar days after being selected as a Clinical Peer, on whether the requested health care service or treatment should be covered. If the Clinical Peer’s opinion was initially made orally, the Clinical Peer shall provide the IRO written confirmation of the opinion within 48 hours after the opinion was initially made. In reaching an opinion, Clinical Peers are not bound by any decisions or conclusions reached by The Plan. Each Clinical ▇▇▇▇'s opinion may be rendered orally or in writing and will include the same information as set forth in the Standard of Review paragraph in the Standard External Review Procedures section, above.