MA H1132

External reviews of medical claims must be conducted by physicians licensed in Massachusetts and board-certified in the relevant medical specialty

Reviewing physicians must be identified to the patient and provide written reports detailing findings, opinions, and citations to peer-reviewed materials supporting their conclusions

Physical examinations of patients are required when circumstances warrant, and reviewing physicians must carry malpractice insurance for services rendered during the external review process

Patients may appeal external review decisions in superior court

Successful court appeals entitle patients to recover all attorney's fees and costs from the risk-bearing provider organization