24 2. The attending health care professional’s recommendation; 3. Reports from appropriate health care professionals and other documents su bmitted by the Plan or issuer, claimant, or the c laimant’s treating provider; 4. The terms of the Non - Grandfathered Plan; 5. Appropriate practice guidelines; 6. Any applicable clinical review criteria developed and used by the Health Benefit Plan ; and 7. The opinion of the IRO’s clinical reviewer. The IRO must provide written notice to the Non - Grandfathered Plan and the c laimant of its final decision within 45 days after the IRO receives the request for the external review. The IRO’s decision notice must contain: 1. A general description of the reason for the external review, including informat ion sufficient to identify the C laim; 2. The date the IRO received the assignment to conduct the review and the date of the IRO’s decision; 3. References to the evidence or documentation the IRO considered in reaching its decision; 4. A discussion of the principal reason(s) for the IRO’s decision; 5. A statement that the determination is binding and that judicial review may be available to the c laimant; and 6. Contact information for any applicable office of health insurance consumer assistance or ombudsman established under federal guidelines. Generally, a c laimant must exhaust the Non - Grandfathered Plan’s claims and appeal procedures in order to be eligible for the external review process. However, an expedited external review is available if: 1. The c laimant receives an Adverse Benefit Determination that involves a medical condition for which the time for completion of the Non - Grandfathered Plan’s internal claims and appeal procedures would seriously jeopardize the c laimant’s life , health or ability to r egain maximum function and the c laimant has filed a request for an expedited internal review; or 2. The c laimant receives a Final Adverse Benefit Determination that involves a medical condition where the time for completion of a standard external review process would seriously jeopardize the c l aimant’s life , health or the c laimant’s ability to regain maximum function, or if the Final Adverse Benefit Determination concerns an admission, availability of care, continued stay, or health care item or service for which the c laimant received emergency services, but has not been discharged from a facility. I mmediately upon receipt of a request for expedited external review, the Non - Grandfathered Plan must determine and notify the c laimant whether the request satisfies the requirements for expedited review, including the eligibility requirements for external review listed above. If the request qualifies for expedited review, it will be assigned to an IRO. The IRO must make its dete rmination and provide a notice of the de cision as expeditiously as the c laimant’s medical condition or circumstances require, but in no event more than 72 hours after the IRO receives the request for an expedited external review. If the original notice of its decision is not in writing, the IRO must provide written confirmati on of the decisi on within 48 hours to both the c laimant and the Non - Grandfathered Plan.