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Texas Department of Insurance
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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:

What are my responsibilities as an IRO?

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:
  • 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 (Redline = striking through superseded language and underlining new language.)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.

Applicable law and rules

Resources

For more information, contact: URAGrp@tdi.texas.gov

Last updated: 8/3/2022