Nebraska Revised Statutes Chapter 44. Insurance § 44-5436. Adverse determinations; appeals; review by physician

(1) Possess a current and valid unrestricted license in a United States jurisdiction;

(2) Be of the same or similar specialty as the ordering physician or have the training and experience to treat the condition, which means that either:

(3) Not have been directly involved in making the initial adverse determination;

(4) Not have any financial interest in the outcome of the appeal; and

(5) Consider all known clinical aspects of the health care service under review, including, but not limited to, a review of those medical records which are pertinent and relevant to the active condition provided to the utilization review agent by the enrollee's health care provider, or a health care facility, and any pertinent medical literature provided to the utilization review agent by the health care provider.