1. Organizational Expectations: Each Applicant must have received approval or accreditation by a nationally recognized private accrediting review entity, such as URAC, approved by the Commissioner. The Applicant shall submit a description of the administration and operation of its organization including how it satisfies the statutory requirements outlined in C.G.S. §§ 38a472f; 38a-591a, et seq, and Regulations of Connecticut State Agencies §§38a-591-1 through 38a-591-11. 2. Service Expectations: The Applicant shall provide documentation that shows the Applicant’s experience in performing similar work. The Applicant shall describe its experience in managed care utilization review, including an explanation of level(s) and scope of involvement in the review process. The Applicant may also provide a list of references including entities for which the applicant has performed utilization review. 3. Staffing Expectations: In responding to this RFP, the Applicant must describe the means by which it will: 1. Select and assign a Clinical Peer who possess the appropriate training and qualifications for the area in which they will be conducting the review. The proposal must include the criteria to be used for the selection or rejection of review personnel; 2. Ensure the availability of appropriate personnel as needed for timely and efficient review; and 3. Ensure the neutrality and objectivity of all personnel conducting external reviews and avoid conflicts of interest as outlined by C.G.S. § 38a-591m. Provide affirmative evidence that no conflict of interest exists upon receiving an assignment.
