RI Gen L § 27-18.9-7(b)(3)(iii-iv)
(iii) When the appeal of any adverse benefit determination, including an appeal of a reconsideration decision, is based in whole or in part on medical judgment, including determinations with regard to whether a particular service, treatment, drug, or other item is experimental, investigational or not medically necessary or appropriate, the reviewer making the appeal decision must be appropriately trained having the same licensure status as the ordering provider or be a physician or dentist and be in the same or similar specialty as typically manages the condition. These qualifications must be provided to the claimant upon request.
(iv) The utilization review agency reviewer must document and sign their decisions.
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