Certification of Independent Review Organizations

• Law on IROs

• Rules for IROs

• IRO Application Form

• Full Patient Bill of Rights Law

Links Outside DOH

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Legal Requirement to Certify Independent Review Organizations (IROs)

Washington's Health Care Patient Bill of Rights Act of 2000 requires health insurance plans to give their enrollees the option to appeal health care coverage and payment disputes to a binding external review if they are not resolved through the plan's internal processes. This part of the Patient Bill of Rights Act (Chapter 5, Laws 2000; formerly Engrossed Second Substitute Senate Bill 6199) took effect July 1, 2001.

The external reviews must be carried out by impartial “independent review organizations” meeting requirements in the law.   Section 12 of the Patient Bill of Rights legislation requires the Department of Health to certify these independent review organizations (IROs). Additional requirements involving IROs are contained in section 11 of the legislation.

 How to Get More Information

• Contact responsible Department of Health staff
• Apply for certification

 Links to Other Information You May Wish

Links to external resources are provided as a public service and do not imply endorsement by the Washington State Department of Health.

• Sections 11 and 12 of the Health Care Patient Bill of Rights Act , containing the legislative requirements for independent review and IRO certification

• The entire Health Care Patient Bill of Rights Act (Chapter 5, Laws 2000), which addresses many topics in addition to independent review

• Information from the Office of the Insurance Commissioner (OIC) on the entire Patient Bill of Rights. OIC is responsible for making sure that health plans provide their enrollees with the option of appealing unresolved issues to external review (IROs). OIC has also developed a means to assign specific cases to IROs on a rotational basis.

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