RSA 415-A:4-a Minimum Standards for Claim Review; Accident and Health Insurance.

Any carrier that offers group health plans and employee benefit plans shall establish and maintain written procedures by which a claimant may obtain a determination of claims and by which a claimant may appeal a claim denial.
I. The procedures for determination of a claim shall meet the following minimum standards:
(a) The plan shall maintain a toll-free telephone number to ensure that a representative of the plan shall be accessible by telephone to insureds, patients, and claimant's representatives as required to meet the response times specified herein.
(b) Clinical review criteria considered or utilized in making claim benefit determinations shall be:
(1) Developed with input from appropriate practitioners with professional knowledge or clinical expertise