The Tennessee External Review Organization license
External Review Organization
Reviews a health carrier's refusal from outside it, at the covered person's request. Tennessee approves it rather than licensing it, for $500, and the conflict of interest rules run to six separate people it may not be connected to.
Course
None
This license has no pre-licensing course route.
Ways in
1
There is no state exam for this license.
Exam
n/a
Not required on any of the routes below.
Every way to qualify
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Route 1 Apply for approval
No state exam for this license
Accreditation
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URAC URAC Independent Review Organization accreditation, or accreditation by another nationally recognized private accrediting entity Tennessee approves, evidenced with the application, from URAC, the American Accreditation Healthcare Commission
and written policies and procedures
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Written policies and procedures governing every part of the standard and expedited external review processes, including a quality assurance mechanism that keeps reviews inside their timeframes, and written procedures ensuring the organization is unbiased.
and clinical reviewers
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Clinical reviewers who are experts in the treatment of the covered person's medical condition and knowledgeable about the recommended service through recent or current clinical experience with the same or a similar condition.
and no conflict of interest
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No material professional, familial or financial conflict of interest with the health carrier, the covered person or their representative, any officer, director or management employee of the carrier, the recommending provider or their medical group or independent practice association, the facility where the treatment would be given, or the developer or manufacturer of the drug, device or procedure being recommended.
and character
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Biographical information for the organization's officers and directors, on the NAIC's biographical affidavit form, stamped confidential by the organization.
Title 56, chapter 61 of the Tennessee Code, the Tennessee Health Carrier Grievance and External Review Procedure Act, part 120 for approval and part 121 for the minimum qualifications. The Department calls the instrument an approval and calls the organization an External Review Organization, while the parts of the Act it prints on its own form are headed Independent Review Organizations, so both names are the Department's. The fee is $500 and the form calls it an accredited entity fee. There is no examination and no course.
Read at the Department on 2026-08-20
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The qualification is a national accreditation held by an organization rather than anything a person studies for. No national seller prices a product for it.