North Dakota Century Code Title 26.1. Insurance § 26.1-36.12-04. Personnel qualified to review appeals

a. Shall possess a valid nonrestricted license to practice medicine.

b. Must be in active practice in the same or similar specialty as the physician who typically manages the medical condition or disease for at least five consecutive years.

c. Must be knowledgeable of, and have experience providing, the health care services under appeal.

d. May not receive any financial incentive based on the number of adverse determinations made. This subdivision does not apply to financial incentives established between health plan companies and health care providers.

e. May not have been directly involved in making the adverse determination.

f. Shall consider all known clinical aspects of the health care service under review, including a review of all pertinent medical records provided to the prior authorization review organization by the enrollee's health care provider, any relevant records provided to the prior authorization review organization by a health care facility, and any medical literature provided to the prior authorization review organization by the health care provider.