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The Idaho Health Carrier External Review Act took effect on January 1, 2010. The Act provides a covered person the right to have a health claim denial reviewed by an independent review organization (IRO) if the denial is based on the health carrier’s requirements for medical necessity, appropriateness, health care setting, level of care, effectiveness or is determined to be investigational.


Expand Section Information regarding this act

Expand Section IROs must comply with Idaho requirements

  Minimum IRO Qualifications (§41-5912)

Expand Section Written Policies and Procedures

Expand Section Clinical Reviewers

Expand Section Conflict of Interest

Expand Section Accreditation

Expand Section Funding for External Review

Expand Section Termination of IRO

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