Section 26-A1902. INITIATION OF PEER REVIEW

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1902.1If an insurer has specific questions concerning the diagnosis or treatment given or, prescribed, by a physician, psychologist, or social worker, the insurer may request that the health professional undergo peer review as a condition of approving payment or reimbursement.

1902.2Peer review shall be conducted by an appropriate committee of physicians, psychologists, or social workers as applicable under the Act.

1902.3The insurer shall give substantial weight to the decision of any peer review committee, but shall not be bound by its determination.

1902.4If initiation of peer review is requested by the insurer the request shall not be made to circumvent the Act or prolong payment or reimbursement of a claim.

source

Final Rulemaking published at 36 DCR 4922 (July 14, 1989).

                    
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