TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER ww: HEALTH CARE SERVICE PLANS
PART 4530 HEALTH CARRIER EXTERNAL REVIEW
SECTION 4530.60 REGISTRATION OF INDEPENDENT REVIEW ORGANIZATIONS
Section 4530.60 Registration of Independent Review Organizations
a) On or after July 1, 2010, an independent review organization may not conduct external reviews for persons subject to Section 15 of the Act unless the independent review organization has registered with the Director. An application for registration shall be in the format set forth in Appendix C and must be signed by an officer or director of the independent review organization. Initial registration applications shall be deemed approved unless the Director finds an application to be noncompliant with either the standards set forth in Section 55 of the Act or this Part.
b) An independent review organization must register with the Director every 2 years. A fee of $1,000 must be submitted with each application or renewal. If the Director determines that there are no acceptable nationally recognized private accrediting entities providing independent review organization accreditation, he or she may then approve independent review organizations that are not accredited by a nationally recognized private accrediting entity, in which case the fee for each application or renewal shall be $1,500.
c) Any material changes in the information filed pursuant to this Part shall be filed with the Director within 30 days after the change. Loss of accreditation status will require re-registration and payment of the appropriate fee pursuant to subsection (b).
d) Renewals and Appeals
1) A registered independent review organization may continue to operate, if a renewal application as specified in Appendix D and fee have been filed 30 days prior to the renewal date, until the renewal is denied or issued by the Director.
2) If the renewal application and fee are not received prior to the renewal date, the registration will automatically expire and the independent review organization must re-register and pay a fee pursuant to subsection (b).
3) If an application for registration or renewal is denied under this Part, the applicant may appeal the denial by requesting a hearing under the terms of Article 10 of the Illinois Administrative Procedure Act [5 ILCS 100/Art. 10] and 50 Ill. Adm. Code 2402. A petition for hearing must be postmarked no later than 30 days from the date of initial denial. A hearing shall be scheduled within 45 days after the petition is filed with the Director. A decision by the Director shall be rendered within 60 days after the close of the hearing.