Last Update: 11/23/16

Chapter 284-43A WAC

INDEPENDENT REVIEW ORGANIZATIONS (IROs)

WAC Sections

SUBCHAPTER A
GENERAL PROVISIONS
Purpose and scope.
Definitions.
SUBCHAPTER B
CERTIFICATION AND REQUIREMENTS FOR INDEPENDENT REVIEW ORGANIZATIONS (IROs)
General requirements for certification.
Application for certification as an IRO.
Administrative processes and capabilities of IROs.
Conflict of interest.
Expert reviewers.
Independent review process.
Criteria and considerations for independent review determinations.
Additional requirements for experimental or investigational treatment reviews.
Ongoing requirements for IROs.
Powers of the commissioner.
Grounds for action against an applicant or a certified IRO.
Maximum fee schedule.
SUBCHAPTER C
REQUIREMENTS FOR CARRIERS IN USING INDEPENDENT REVIEW ORGANIZATIONS (IROs)
External review of adverse benefit determinations.
Independent review of adverse determinations.
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