External Review

Forms and resources for external review

15 resources in this category

External Review Request Guide - California

How to request an independent medical review through the California DMHC after exhausting internal appeals.

Guide to requesting external appeal through the New York DFS for health insurance claim denials.

How to file for independent review through the Texas DOI for denied health insurance claims.

Guide to requesting external review of health plan denials through the Florida OIR process.

How to request independent external review through the Illinois DOI after an adverse benefit determination.

Guide to filing for external grievance review through the Pennsylvania Insurance Department.

How to request independent external review through the Ohio DOI for medical necessity and coverage denials.

Guide to requesting external review of health insurance denials through the Georgia OCI.

How to file for external review through the Michigan DIFS after exhausting internal insurance appeals.

Guide to requesting independent utilization review through the New Jersey DOBI.

How to request a federally administered external review for self-funded employer plans under ACA regulations.

Guide to external review options for ERISA-governed employer health plans including DOL complaint procedures.

Checklist of required documents and information needed to submit a complete external review application.

Worksheet to track external review deadlines, submission dates, and expected decision timelines.

Overview of how Independent Review Organizations evaluate external review cases and what to include in your submission.