Independent Review Organization

IC 27-13-10.1, effective 1/1/2000 for HMOs and IC 27-8-28, effective 7/1/2001 for all issuers of accident and sickness insurance policies, requires that these entities doing business in Indiana establish and maintain an external grievance procedure for the resolution of grievances regarding adverse utilization review determinations, adverse determinations of medical necessity or determinations that a proposed service is experimental or investigational. The Department of Insurance (Department) is required to establish and maintain a process for annual certification of independent review organizations and to maintain a list of certified independent review organizations (IROs) to be used by HMOs and other insurers.