Iowa Admin. Code r. 191-76.9

Current through Register Vol. 47, No. 11, December 11, 2024

Rule 191-76.9 - Certification of independent review organization

(1) In addition to the minimum qualifications set forth in Iowa Code section 514J.112, the following minimum standards are required for certification as an independent review organization:

a. The applicant shall provide a description of the procedures employed to comply with Iowa Code section 514J.112(1)"a."

b. The applicant shall provide the number of reviewers retained by the independent review organization and a description of the areas of expertise available from such reviewers and the types of cases such reviewers are qualified to review.

c. The applicant shall provide the names and résumés of all directors, officers, and executives of the independent review organization.

d. The applicant shall provide a description of the fees to be charged to the carrier by the independent review organization for external reviews.

e. The applicant shall provide the name of the medical director or health professional director responsible for the supervision and oversight of the independent review procedure.

(2) The independent review organization shall develop written policies and procedures to ensure adherence to the requirements of this chapter and Iowa Code chapter 514J by any contractor, subcontractor, subvendor, agent or employee affiliated with the certified independent review organization.

(3) In addition to the toll-free telephone service required by Iowa Code section 514J.112(1)"b," the independent review organization shall establish a facsimile and electronic mail service to receive information relating to external reviews pursuant to this chapter and Iowa Code chapter 514J.

(4) The independent review organization shall provide the commissioner within ten business days of request such data, information, and reports as the commissioner determines necessary to evaluate the external review process established under Iowa Code chapter 514J or a report in the format of Appendix C to comply with Iowa Code section 514J.114(1).

(5) Applications shall be submitted to the Commissioner of Insurance, 1963 Bell Avenue, Suite 100, Des Moines, Iowa 50315; or as designated by the commissioner. Applications must be submitted in full to be considered. The form for initially approving and for reapproving independent review organizations required by Iowa Code section 514J.111(4) shall be in the form of Appendix E. If the commissioner designates an entity to review applications, the designee may charge a fee, as permitted by Iowa Code section 514J.111(5) and as approved by the commissioner. All applicants will be notified of the certification decision.

(6) A list of certified independent review organizations shall be maintained by the commissioner and shall be available through the website of the Iowa insurance division, iid.iowa.gov.

Iowa Admin. Code r. 191-76.9

Adopted by IAB June 22, 2016/Volume XXXVIII, Number 26, effective 7/27/2016

Amended by IAB December 29, 2021/Volume XLIV, Number 13, effective 2/2/2022