In Montana an Independent Review Organization (IRO) may perform external appeals for health and long-term care. Pursuant to MCA § 33-32-416 and ARM 6.6.3131, 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. The approval is effective for two years.
The initial application is for entities, not currently on the approved CSI list, seeking approval to serve in Montana as an IRO. 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. The CSI will contact your entity with its determination regarding the application of your entity.
Pursuant to MCA § 33-32-419, effective October 1, 2019, there is a $250 application fee required for processing an application for a new IRO applying for approval to conduct health external appeals. There is a $150 application fee for an IRO applying to renew the company’s approval to conduct health external appeals and remain on the CSI’s approved IRO list. There is no application fee for apply or renewing to be an approved IRO for long-term care external appeals. Companies must mail the application fee to 840 Helena Avenue, Helena MT 59601. Please direct payment to the attention of Market Conduct – IRO Application Fee. New and Renewal applications will not be processed and approved until payment is received by this office
Questions? Please contact David Dachs at firstname.lastname@example.org.
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
Please upload only the renewal application and any of the documents listed above that have been updated or changed since your last approval by CSI.