Iro organization

Independent Review Organization (IRO) RCW and WAC

Learn more about RCWs and WACs related to Independent Review Bodies (IRO) engagements.

IRO RCW

Each RCW link will take you to the Washington State Legislature website (leg.wa.gov).

BRF 48.005 Definitions

RCW 48.43.530 Requirement for carriers to have comprehensive complaint and appeal processes (carrier’s obligations, procedures, appeals and rules)

RCW 48.43.535 Independent Review of Healthcare Disputes (System of Use of Certified Independent Review Bodies and Rules)

RCW 48.43.537 Healthcare Disputes (Independent Review Body Certification, Application, Restrictions, Schedule of Maximum Fees for Conducting Reviews and Rules)

IRO WAC

Each WAC link will take you to the Washington State Legislature website (leg.wa.gov).

WAC 284-43A-001 Purpose and Scope

WAC 284-43A-010 Definitions

WAC 284-43A-020 General Requirements for Certification

WAC 284-43A-030 Application for certification as an IRO

WAC 284-43A-040 Business Processes and IRO Capabilities

WAC 284-43A-050 Conflict of Interest

WAC 284-43A-060 Expert Reviewers

WAC 284-43A-070 Independent Review Process

WAC 284-43A-080 Criteria and Considerations for Independent Review Decisions

WAC 284-43A-090 Additional Requirements for Examinations of Investigational or Investigational Treatments

WAC 284-43A-100 Continuing Requirements for IROs

WAC 284-43A-110 Powers of Commissioner

WAC 284-43A-120 Grounds of Action Against a Plaintiff or Certified IRO

WAC 284-43A-130 Maximum fee schedule

WAC 284-43A-140 External Review of Adverse Benefit Determinations

WAC 284-43A-150 Independent Review of Adverse Decisions