# WAC 284-43A-020: WAC 284-43A-020. General requirements for certification

> Washington · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_020

## Section

- **Citation:** WAC 284-43A-020
- **Heading:** WAC 284-43A-020. General requirements for certification
- **Jurisdiction:** Washington
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Washington Administrative Code / Title 284 / Chapter 284-43A / Section 284-43A-020

## Text

In order to qualify for certification, an IRO shall:
(1) Submit an application for certification to the commissioner as described in RCW 48.43.537 .
(2) Hold a current accreditation from a nationally recognized private accrediting organization acceptable to the federal Department of Health and Human Services or Department of Labor for the federal external review process.
(3) Demonstrate expertise and a history of reviewing health care in terms of medical necessity, appropriateness, and application of other health plan coverage and contract provisions.
(4) Demonstrate the ability to handle a full range of review cases, including contract provisions, occurring in Washington state. Certified IROs may contract with more specialized review organizations; however, the certified IRO shall ensure that each review conducted meets all the requirements of this chapter.
(5) Demonstrate capability to review administrative and contractual coverage issues, as well as medical necessity and effectiveness, and the appropriateness of experimental and investigational treatments.
(6) Comply with all conflict of interest provisions in WAC 284-43A-050 .
(7) Maintain and assign qualified expert reviewers in compliance with WAC 284-43A-060 .
(8) Conduct reviews, reach determinations and document determinations consistent with WAC 284-43A-040 through 284-43A-090 .
(9) Maintain administrative processes and capabilities in compliance with WAC 284-43A-040 .

## Nearby sections

- [WAC 284-43A-001 WAC 284-43A-001. Purpose and scope](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_001.md)
- [WAC 284-43A-010 WAC 284-43A-010. Definitions](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_010.md)
- [WAC 284-43A-020 WAC 284-43A-020. General requirements for certification](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_020.md)
- [WAC 284-43A-030 WAC 284-43A-030. Application for certification as an IRO](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_030.md)
- [WAC 284-43A-040 WAC 284-43A-040. Administrative processes and capabilities of IROs](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_040.md)
- [WAC 284-43A-050 WAC 284-43A-050. Conflict of interest](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_050.md)
- [WAC 284-43A-060 WAC 284-43A-060. Expert reviewers](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_060.md)
- [WAC 284-43A-070 WAC 284-43A-070. Independent review process](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_070.md)
- [WAC 284-43A-080 WAC 284-43A-080. Criteria and considerations for independent review determinations](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_080.md)
- [WAC 284-43A-090 WAC 284-43A-090. Additional requirements for experimental or investigational treatment reviews](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_090.md)
- [WAC 284-43A-100 WAC 284-43A-100. Ongoing requirements for IROs](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_100.md)
- [WAC 284-43A-110 WAC 284-43A-110. Powers of the commissioner](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_110.md)
- [WAC 284-43A-120 WAC 284-43A-120. Grounds for action against an applicant or a certified IRO](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_120.md)
- [WAC 284-43A-130 WAC 284-43A-130. Maximum fee schedule](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_130.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43A_020. Check the current official text before relying on it. Not legal advice.