For Consumers

Independent review organization (IRO) search tips

How to use the independent review organization (IRO) decision-lookup tool

  • Select an option from one or more of the tool’s drop-down menus
  • Click "Search"
  • Select an IRO decision from the search results

! Helpful tip

Sort the search results by selecting the column heading in the search result.

Search options

Year of decision

Search the year when a final decision was issued by an IRO.

  • Select the year you’d like to see from the drop-down menu
  • Click "Search" to view IRO decisions

! Helpful tip

Only IRO decisions submitted since 2016 are displayed.

Health insurer

Display IRO decisions involving a particular insurance company.

  • Select the name of the insurance company from the drop-down menu
  • Click "Search" to view the IRO decisions

! Helpful tip
Don’t see an insurance company in the drop-down list? We may have not received an IRO decision involving your company, or your company may not be licensed with our office. Please call our Insurance Consumer Hotline at 800-562-6900 or email our office for further information.

Independent review organization (IRO)

Search for decisions issued by a particular IRO.

  • Select the name of the IRO you’d like to see from the drop-down menu
  • Click "Search" to view the IRO decisions

Outcome

Search an IRO decision by its outcome (upheld, overturned, withdrawn by carrier or withdrawn by enrollee).

  • Select the outcome you’d like to use in your search from the drop-down menu
  • Click "Search" to view the IRO decisions

Keyword search

Search by focusing on one particular keyword or topic.

  • Enter your word in the keyword search box
  • Click "Search" to view the IRO decisions that include your word

! Helpful tip
Remember: Spelling counts! Although capitalization doesn’t matter, correct spelling will give you better search results.

Diagnosis

Search for IRO decisions involving a diagnosed medical condition.

  • Select the diagnosis code you’d like to see from the drop-down menu
  • Click "Search" to view the IRO decisions involving this diagnosis code

! Helpful tip
If you don’t know the ICD code for a diagnosed medical condition, consult your medical provider or your health insurer.

Diagnosis subcategory

Search for IRO decisions involving a subcategory of a diagnosed medical condition.

  • Select the subcategory code from the drop-down menu
  • Click "Search" to view the IRO decisions involving this subcategory

! Helpful tip
Don’t see a certain diagnosis subcategory? We may not have received an IRO decision with that ICD code.

Treatment

Search IRO decisions involving a specific type of medical treatment.

  • Select the treatment code you’d like to see from the drop-down menu
  • Click "Search" to review the IRO decisions involving this treatment

! Helpful tip
If you’re searching for a treatment CPT code for your own denied claim, your insurance company’s explanation of benefits or denial notice should contain the appropriate code for your case.

Don’t see a certain treatment category when searching? We may have not have received an IRO decision that involves this particular CPT code.

Reason

Use this option to search for the reason a health insurer denied a claim (medically necessary services, experimental/investigational therapies, contractual coverage dispute).

  • Select the reason you’d like to see from the drop-down menu
  • Click "Search" to view the IRO decisions

! Helpful tip
If you’re searching for a reason involving your own denied claim, your insurance company’s explanation of benefits or denial notice should contain this information.