External Review

Important Notice to Insurers about External Review

External Review Referral Form

Insurers should use this form, which is available in three formats, to request assignment of an independent review organization.

Interactive version: Fill in the fields and submit the form to the Insurance Division.

Word version: Download the form, enter the information, and e-mail the form to us as an attachment, or fax or mail it to us.

PDF version: Download the form, fill it out, and fax or mail it to us.

External Review Annual Summary Form

Word version: Download the form, enter the information, and e-mail the form to us as an attachment, or fax or mail it to us.

PDF version: Download the form, fill it out, and fax or mail it to us.