Pennsylvania Statutes Title 40 P.S. Insurance § 991.2164i. Department approval of independent review organizations

(1) Except as otherwise provided in this section, be accredited by a nationally recognized private accrediting entity that the department has determined to possess IRO accreditation standards that are equivalent to or exceed the minimum qualifications for the IROs established under section 2164.10.  2

(2) Submit an application for approval in accordance with subsection (d).

(3) Identify the IRO's proposed fees for external reviews.

(1) An IRO seeking approval to conduct external reviews under section 2162 or this subdivision shall submit the application form and include with the form all documentation and information necessary for the department to determine whether the IRO satisfies the minimum qualifications established under section 2164.10.

(2) The department may approve an IRO that is not accredited by a nationally recognized private accrediting entity if there are no acceptable nationally recognized private accrediting entities providing IRO accreditation.

(3) The department may charge the IRO an application fee to be submitted with an application for approval or for renewal.

(4) The department may decline to certify an IRO if the IRO's proposed fees for external reviews are determined by the department to be unreasonable.

(1) An approval shall be valid for two years unless the department determines before the approval expires that the IRO no longer satisfies the minimum qualifications established under section 2164.10.

(2) If the department determines that an IRO is no longer accredited or no longer satisfies the minimum requirements established under section 2164.10, the department may terminate the approval of the IRO and remove the IRO from the list of IROs approved to conduct external reviews under this subdivision.