An Independent Review Organization, as defined in Iowa Code chapter 514J, is an entity that conducts independent external reviews of adverse determinations made by health carriers. External reviews can be conducted of certain adverse determinations related to dental insurance. For details about external reviews, see Iowa Code chapter 514J and Iowa Administrative Code rule 191.76.
To conduct external reviews, independent review organizations must submit applications for approval, using Appendix E of Iowa Administrative Code rule 191.76, to the Iowa Insurance Commissioner's designee by email or by postal mail at the following address:
Jaqueline Buol, BA University of Iowa Clinical Staff Office 200 Hawkins Drive, C123 GH Iowa City, Iowa, 52242-500
Independent review entities also can apply to be certified by the commissioner to conduct independent reviews of insurers’ adverse benefit trigger determinations related to long-term care insurance. For details about independent reviews of long-term care insurance benefit trigger determinations, see Iowa Code section 514G.110.
To conduct independent review of long-term care determinations, an independent review entity must file a written request for certification which demonstrates the qualifications set forth in Iowa Code section 514G.110.
Certifications and approvals need to be renewed every two years.
For a listing of approved and certified Independent Review Organizations in Iowa, click here or view the data set below.
If you need assistance, please contact the Iowa Insurance Division.