TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE
SUBCHAPTER ww: HEALTH CARE SERVICE PLANS
PART 4530 HEALTH CARRIER EXTERNAL REVIEW
SECTION 4530.50 INDEPENDENT REVIEW ORGANIZATION OBLIGATIONS
Section 4530.50 Independent Review Organization Obligations
a) An independent review organization may not conduct external independent reviews of adverse determinations for persons subject to Section 15 of the Act unless the independent review organization has first registered with the Director. An application for registration shall be in the format set forth in Appendix C.
b) An independent review organization must secure and maintain a current certificate of accreditation by the American Accreditation Healthcare Commission (URAC) under applicable standards for Independent Review Organizations.
c) Each independent review organization shall provide a written notice as set forth in Appendix A and Appendix B, explaining its decision to uphold or reverse adverse or final adverse determinations to the health carrier, the covered person, and, if applicable, the covered person's authorized representative.
d) Each independent review organization shall maintain written records in the aggregate, by state, and by health carrier on all requests for external review for which it conducted an external review during a calendar year and submit, electronically, a report in the format specified by the Director by March 1 of each year. The independent review organization shall retain the written records required under the Act for at least three years.
(Source: Amended at 39 Ill. Reg. 12577, effective September 1, 2015)