1. The commissioner shall approve applications submitted by independent review organizations to conduct external reviews under this chapter. The commissioner may retain an outside expert to perform reviews of such applications.

Terms Used In Iowa Code 514J.111

  • Commissioner: means the commissioner of insurance. See Iowa Code 514J.102
  • following: when used by way of reference to a chapter or other part of a statute mean the next preceding or next following chapter or other part. See Iowa Code 4.1
  • Independent review organization: means an entity that conducts independent external reviews of adverse determinations and final adverse determinations. See Iowa Code 514J.102
  • Rule: includes "regulation". See Iowa Code 4.1
 2. In order to be eligible for approval by the commissioner to conduct external reviews, an independent review organization shall meet all of the following requirements:

 a. Be accredited by a nationally recognized private accrediting entity that the commissioner determines has independent review organization accreditation standards that are equivalent to or exceed the minimum qualifications for independent review organizations established in this chapter.
 b. Submit an application in a form and format as directed by the commissioner.
 c. Meet the minimum qualifications contained in section 514J.112.
 3. The commissioner may approve independent review organizations that are not accredited by a nationally recognized private accrediting entity if there are no acceptable nationally recognized private accrediting entities providing independent review organization accreditation.
 4. The commissioner shall develop an application form for initially approving and for reapproving independent review organizations to conduct external reviews.
 5. The commissioner may charge an initial application fee and a renewal fee as specified by rule.
 6. The approval of an independent review organization to conduct external reviews by the commissioner pursuant to this chapter is effective for two years, unless the commissioner determines that the independent review organization is not satisfying the minimum qualifications of this chapter. If the commissioner determines that an independent review organization has lost its accreditation or no longer satisfies the minimum requirements established under this chapter, the commissioner shall terminate approval of the independent review organization to conduct external reviews and remove the independent review organization from the list of independent review organizations approved to conduct external reviews that is maintained by the commissioner.
 7. The commissioner shall maintain a list of currently approved independent review organizations.
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