medically reviewable decisions shall be 
the subject of independent medical re-
view and with the requirement of sub-
section (d)(3) that independent med-
ical reviewers may not require cov-
erage for specifically excluded bene-
fits. 
(v) PERIOD OF CERTIFICATION OR RE-
CERTIFICATION.—A certification or recer-
tification provided under this paragraph 
shall extend for a period not to exceed 2 
years. 
(vi) REVOCATION.—A certification or 
recertification under this paragraph may 
be revoked by the appropriate Secretary or 
by the organization providing such certifi-
cation upon a showing of cause. The Sec-
retary, or organization, shall revoke a cer-
tification or deny a recertification with re-
spect to an entity if there is a showing that 
the entity has a pattern or practice of or-
dering coverage for benefits that are spe-
cifically excluded under the plan or cov-
erage.
(vii) PETITION FOR DENIAL OR WITH-
DRAWAL.—An individual may petition the 
Secretary, or an organization providing the 
certification involves, for a denial of recer-
tification or a withdrawal of a certification 
with respect to an entity under this sub-
paragraph if there is a pattern or practice 
of such entity failing to meet a require-
ment of this section. 
(viii) SUFFICIENT NUMBER OF ENTI-
TIES.—The appropriate Secretary shall 
certify and recertify a number of external 
review entities which is sufficient to ensure 
the timely and efficient provision of review 
services. 
(D) PROVISION OF INFORMATION.— 
(i) IN GENERAL.—A qualified external 
review entity shall provide to the appro-
priate Secretary, in such manner and at 
such times as such Secretary may require, 
such information (relating to the denials 
which have been referred to the entity for 
the conduct of external review under this 
section) as such Secretary determines ap-
propriate to assure compliance with the
independence and other requirements of 
this section to monitor and assess the qual-
ity of its external review activities and lack 
of bias in making determinations. Such in-
formation shall include information de-
scribed in clause (ii) but shall not include 
individually identifiable medical informa-
tion. 
(ii) 
INFORMATION
TO
BE
IN-
CLUDED.—The information described in 
this subclause with respect to an entity is 
as follows: 
(I) The number and types of de-
nials for which a request for review 
has been received by the entity. 
(II) The disposition by the entity 
of such denials, including the number 
referred to a independent medical re-
viewer and the reasons for such dis-
positions (including the application of 
exclusions), on a plan or issuer-spe-
cific basis and on a health care spe-
cialty-specific basis.
(III) The length of time in mak-
ing determinations with respect to 
such denials. 
(IV) Updated information on the 
information required to be submitted 
as a condition of certification with re-
spect to the entity’s performance of 
external review activities. 
(iii) INFORMATION TO BE PROVIDED 
TO CERTIFYING ORGANIZATION.— 
(I) IN GENERAL.—In the case of 
a qualified external review entity 
which is certified (or recertified) 
under this subsection by a qualified 
private standard-setting organization, 
at the request of the organization, the 
entity shall provide the organization 
with the information provided to the 
appropriate Secretary under clause 
(i). 
(II) 
ADDITIONAL
INFORMA-
TION.—Nothing in this subparagraph 
shall be construed as preventing such 
an organization from requiring addi-
tional information as a condition of