2009 Iowa Code
Title 13 - Commerce
Subtitle 1 - Insurance and Related Regulation
CHAPTER 514J - EXTERNAL REVIEW OF HEALTH CARE COVERAGE DECISIONS
514J.6 - INDEPENDENT REVIEW ENTITIES.

        514J.6  INDEPENDENT REVIEW ENTITIES.
         1.  The commissioner shall solicit names of independent review
      entities from carriers, organized delivery systems, and medical and
      health care professional associations.
         2.  Independent review entities include, but are not limited to,
      the following:
         a.  Medical peer review organizations.
         b.  Nationally recognized health experts or institutions.
         3.  The commissioner shall certify independent review entities to
      conduct external reviews.  An individual who conducts an external
      review as or as part of a certified independent review entity shall
      be a health care professional and satisfy both of the following
      requirements:
         a.  Hold a current unrestricted license to practice medicine
      or a health profession in the United States.  A health care
      professional who is a physician shall also hold a current
      certification by a recognized American medical specialty board.  A
      health care professional who is not a physician shall also hold a
      current certification by such professional's respective specialty
      board.
         b.  Have no history of disciplinary actions or sanctions,
      including, but not limited to, the loss of staff privileges or any
      participation restriction taken or pending by any hospital or state
      or federal government regulatory agency.
         4.  Each independent review entity shall have a quality assurance
      program on file with the commissioner that ensures the timeliness and
      quality of the reviews, the qualifications and independence of the
      experts, and the confidentiality of medical records and review
      materials.
         5.  The commissioner shall certify independent review entities
      every two years.  

         99 Acts, ch 41, §12, 22
         Referred to in § 514J.2