Independent Review Organizations (IRO)

How do I find a certified IRO?

The TDI Managed Care Quality Assurance Office (MCQA) issues certifications for IROs. Once an IRO is certified to perform independent reviews to determine medical necessity, MCQA adds the IRO to the Certified IRO list. If you need additional assistance locating an IRO, contact MCQA at 866-554-4926.

How do I become an IRO?

To apply for certification as an IRO:

Applicant must complete all items of the IRO application form, Form LHL006 (PDF). Do not leave any spaces blank – indicate "NA" if appropriate.
- Label each attachment. For example, Exhibit 3: Attachment B, Certification of Compliance.
- Filing Fee of $1,000 must be included and must be made payable to the Texas Department of Insurance. The fee is non-refundable.
Applicant is required to submit:
- An NAIC Biographical Affidavit. Click on the “Primary App” tab and look for Form #11.
- An Addendum to Biographical Affidavit, Form LHL711 (PDF), for each director, officer, and executive of the applicant.
All applicants for licensure must comply with Texas Administrative Code (TAC), Title 28, Subchapter D. This includes fingerprint requirements outlined in Section 1.504. See also Fingerprint requirements and instructions.

What are my responsibilities as an IRO?

An IRO determines the medical necessity and appropriateness of health care delivered or proposed to be delivered by a health care provider.
An IRO is responsible for assigning the case to an appropriate specialty reviewer who must certify they have no conflict of interest.
More information about IRO responsibilities is found in the following places:
- Decision Time Frames (PDF)
- Notice of IRO Decisions Templates:
  - Health Care Template, Form LHL712 (Word)
  - Workers' Compensation Template, Form LHL713 (Word)
- Certification of independence and qualifications of the Reviewer Form LHL709 (PDF)
- Disability management webpage

IRO renewals and updates to application

Renewals

An IRO must apply for renewal of the certificate every two years after the date of certification.
If the renewal application is not received by TDI before or on the date of expiration, the certification will automatically expire. The IRO must submit a new original application and the filing fee for an original application.
Independent reviews will not be assigned to an IRO during the 30 days before the anniversary date of the issuance of the IRO’s certificate of registration unless the completed renewal application form and application fee have been received by TDI.
To renew a certification, the IRO, can apply one of two ways:
- File the renewal application electronically. Learn how on our Renew IRO certification online webpage.
  or
- Use the IRO application form, Form LHL006 (PDF), and attach the Supplemental Certification for IRO Renewal, Form LHL007 (PDF).
Pay the renewal fee of $400. Make payable to the Texas Department of Insurance. The fee is non-refundable.

Material changes / updates to applications

The IRO must provide notice of material change within 30 days of the change taking effect.
Material changes can include:
- New officers and directors.
- New contact.
- Changes in organizational structure.
- Changes in contractual relationships.
- Changes in the independent review plan.
- Changes relating to physicians and providers performing independent reviews.
- Updates to previously filed exhibits, attachments, or documents.
To give notice of material change, the IRO must provide a list and explanation of the change on company letterhead.
It must be signed by an authorized representative.

If the material change involves a previously filed exhibit, attachment, or document, a redline version of the item must be included. (Redline = striking through superseded language and underlining new language.)
There is no fee to update or change an application.