Independent Review Organization Application

This application is for entities seeking approval to serve in Montana as an Independent Review Organization (IRO). Pursuant to MCA § 33-32-416, an IRO must obtain the approval of the Office of the Montana State Auditor, Commissioner of Securities and Insurance (CSI) to perform external review services. To apply, please complete this form and attach the required documentation. The CSI will contact your entity with its determination regarding the application of your entity.

Questions? Please contact David Dachs at ddachs@mt.gov.

Please upload:

  1. The Independent Review Organization Application
  2. Documentation of Accreditation
  3. Statement of disciplinary action, sanction, or consent agreement or other settlement by or with any hospital, government agency, government unit, or regulatory body
  4. Statement identifying the areas of expertise for which the applicant provides independent review, and the number of reviewers meeting the qualification requirements of Mont. Code Ann. § 33-32-417 within each respective area of expertise
  5. Fee Schedule
  6. Copies of policies and procedures governing all aspects of both the standard external review process and the expedited external review process
  7. Document summarizing, for each policy or procedure, the aspect or aspects of external review processes that the policy or procedure governs
  • Drop files here or
    Accepted file types: pdf.