INDEPENDENT REVIEW ORGANIZATION (IRO)
Health insurance Independent Review Organizations (IRO) are regulated under Title 33, Chapter 32, MCA, and Admin. R. M. Title 6, Chapter 32.
Long-term care insurance IROs are regulated under Title 33, Chapter 22, Part 11, MCA, and Admin. R. M. Title 6, Chapter 31.
In Montana an IRO may perform external appeals for health and long-term care insurance. The approval is effective for two years.
The initial application is for entities not currently on the approved CSI list. The initial application should also be completed by entities seeking to expand their approval status to the other line of business for which they are not currently approved to perform external appeals. The renewal application is for currently approved entities seeking approval to continue to serve in Montana as an IRO. To apply or renew, please complete the appropriate IRO application and attach the required documentation.
IRO APPLYING FOR FIRST-TIME APPROVAL TO CONDUCT HEALTH INSURANCE EXTERNAL APPEALS
- Pursuant to MCA § 33-32-419(1), $250 application fee is required.
- Pursuant to MCA § 33-32-419(2), $150 application fee is required for an IRO applying to renew the company’s approval to conduct health external appeals and remain on the CSI approved IRO list.
Please mail the application fee to:
- Commissioner of Securities and Insurance | Attn: Market Conduct—IRO Application Fee | 840 Helena Avenue | Helena MT 59601
New and Renewal applications for IROs to conduct health external appeals will not be processed and approved until payment is received by this office.
LONG-TERM CARE INSURANCE EXTERNAL APPEALS
- No fee required.
Questions? Please call 800.332.6148 or 406.444.2040 or email firstname.lastname@example.org.
Independent Review Organizations (IRO) Applicants & Renewals
NEW APPLICANTS (please upload):
- The Independent Review Organization Application
- Documentation of Accreditation
- Statement of disciplinary action, sanction, or consent agreement or other settlement by or with any hospital, government agency, government unit, or regulatory body
- Statement identifying the areas of expertise for which the applicant provides independent review, and the number of reviewers meeting the qualification requirements of MCA § 33-32-417, and if applicable ARM 6.6.3120(1)(h), within each respective area of expertise
- Fee Schedule
- Copies of policies and procedures governing all aspects of both the standard external review process and the expedited external review process
- Document summarizing, for each policy or procedure, the aspect or aspects of external review processes that the policy or procedure governs
RENEWAL APPLICANTSPlease upload only the renewal application and any of the documents listed above that have been updated or changed since your last approval by CSI.