IRO Certification

Certification of Independent Review Organizations

The Patient’s Right to Independent Review Act (PRIRA) of 1999, codified at O.C.G.A § 33-20A et. seq., requires health insurance plans to give their enrollees the option to appeal health care coverage and payment disputes to a binding external review if they are not resolved through the plan's internal grievance processes.

The external reviews must be carried out by impartial independent review organizations meeting specific requirements in the law.  As the administrator of Georgia’s PRIRA, the Department of Community Health is charged with establishing and maintaining a process for the certification of independent review organizations.

How does my organization apply for certification?

To apply for initial certification as an independent review organization (IRO), please complete the application below.  Once the initial certification is received, the “Renewal of Certificate of Registration” form must be completed annually.  The Department will certify independent review organizations that meet the requirements of the PRIRA and any regulations promulgated by the department consistent with this statute. 

   Application for Certification as an IRO
   Renewal of Certificate of Registration for IRO

Please send your application or renewal form to:

Attention: Independent Review Requests
Office of General Counsel/Division of Health Planning
Georgia Department of Community Health
2 Peachtree Street, NW; 5th Floor
Atlanta, GA 30303-3142

What happens next?

In accordance with the PRIR Administrative Rule 111-2-3-.03(1) et. seq., the Department will review the application and request additional information, as necessary.  A written decision will be issued to the applicant that either approves or denies the application no later than sixty (60) calendar days after the application is deemed complete for review.  If more time is needed, the applicant or the Department may request a thirty (30) calendar day extension of the review period.

Rules

If you have questions regarding the IRO certification process please call (404) 656-0409.

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