(1) Purpose. These rules are adopted by the Washington state office of the insurance commissioner to implement the provisions of RCW 48.43.535
regarding the certification and requirements of independent review organizations (IROs) and requirements for carriers referring review of adverse benefit determinations to IROs. Certified IROs are qualified to receive referrals from the commissioner or designee under RCW 48.43.535
to make binding determinations related to health care coverage and payment disputes between health insurance carriers and their enrollees.
(3) Applicability. These rules apply to independent review cases originating in Washington state under RCW 48.43.535
, and to independent review organizations conducting these reviews.