State process vs. federal
Most states run their own external-review program through a state agency. A small number default to the federal HHS-administered process operated by MAXIMUS. And one rule cuts across all of it: ERISA self-funded plans use the federal process regardless of the state.
Federal-process states
All other states run their own program.
In-depth state guides
Alabama
Defaults to the federal HHS-administered process (MAXIMUS).
How it works in AlabamaAlaska
Runs its own external review through Alaska Division of Insurance.
How it works in AlaskaArizona
State-run External Independent Review — the final step of Arizona's four-level appeal; no fee.
How it works in ArizonaArkansas
Runs its own external review through Arkansas Insurance Department.
How it works in ArkansasCalifornia
State-run Independent Medical Review (IMR) — free, binding, with a six-month filing window.
How it works in CaliforniaColorado
Runs its own external review through Colorado Division of Insurance.
How it works in ColoradoConnecticut
Runs its own external review through Connecticut Insurance Department.
How it works in ConnecticutDelaware
State-run external review — the Independent Health Care Appeals Program.
How it works in DelawareDistrict of Columbia
Runs its own external review through DC Department of Insurance, Securities and Banking.
How it works in District of ColumbiaFlorida
Uses the federal HHS-administered external review (MAXIMUS) — not a state-run program.
How it works in FloridaGeorgia
Defaults to the federal HHS-administered process (MAXIMUS).
How it works in GeorgiaHawaii
Runs its own external review through Hawaii Department of Commerce and Consumer Affairs, Insurance Division.
How it works in HawaiiIdaho
Runs its own external review through Idaho Department of Insurance.
How it works in IdahoIllinois
Runs its own external review through Illinois Department of Insurance.
How it works in IllinoisIndiana
Runs its own external review through Indiana Department of Insurance.
How it works in IndianaIowa
Runs its own external review through Iowa Insurance Division.
How it works in IowaKansas
Runs its own external review through Kansas Insurance Department.
How it works in KansasKentucky
Runs its own external review through Kentucky Department of Insurance.
How it works in KentuckyLouisiana
Runs its own external review through Louisiana Department of Insurance.
How it works in LouisianaMaine
Runs its own external review through Maine Bureau of Insurance.
How it works in MaineMaryland
Runs its own external review through Maryland Insurance Administration.
How it works in MarylandMassachusetts
Runs its own external review through Massachusetts Office of Patient Protection.
How it works in MassachusettsMichigan
State-run external review — the Patient's Right to Independent Review Act (PRIRA).
How it works in MichiganMinnesota
Runs its own external review through Minnesota Department of Commerce.
How it works in MinnesotaMississippi
Runs its own external review through Mississippi Insurance Department.
How it works in MississippiMissouri
Runs its own external review through Missouri Department of Commerce and Insurance.
How it works in MissouriMontana
State external review — filed with the insurer, which randomly assigns an IRO from the state list; 120-day window.
How it works in MontanaNebraska
Runs its own external review through Nebraska Department of Insurance.
How it works in NebraskaNevada
Runs its own external review through Nevada Office for Consumer Health Assistance.
How it works in NevadaNew Hampshire
Runs its own external review through New Hampshire Insurance Department.
How it works in New HampshireNew Jersey
State-run IHCAP external review — free, the state assigns the reviewer; 45-day decisions.
How it works in New JerseyNew Mexico
Runs its own external review through New Mexico Office of Superintendent of Insurance.
How it works in New MexicoNew York
State-run external appeal through the DFS — the state assigns the reviewer; decisions in 30 days.
How it works in New YorkNorth Carolina
State-run external review — the Smart NC.
How it works in North CarolinaNorth Dakota
Runs its own external review through North Dakota Insurance Department.
How it works in North DakotaOhio
Runs its own external review through Ohio Department of Insurance.
How it works in OhioOklahoma
Runs its own external review through Oklahoma Insurance Department.
How it works in OklahomaOregon
State-run external review — the state randomly assigns the reviewer; a 180-day window, published outcomes.
How it works in OregonPennsylvania
Runs its own external review through Pennsylvania Insurance Department.
How it works in PennsylvaniaRhode Island
Runs its own external review through Rhode Island Office of the Health Insurance Commissioner.
How it works in Rhode IslandSouth Carolina
Runs its own external review through South Carolina Department of Insurance.
How it works in South CarolinaSouth Dakota
Runs its own external review through South Dakota Division of Insurance.
How it works in South DakotaTennessee
Runs its own external review through Tennessee Department of Commerce and Insurance.
How it works in TennesseeTexas
Defaults to the federal HHS-administered process (MAXIMUS), not a state program.
How it works in TexasUtah
Runs its own external review through Utah Insurance Department.
How it works in UtahVermont
State-run external review — the state rotates the reviewer; a generous deadline and a free consumer advocate.
How it works in VermontVirginia
Runs its own external review through Virginia State Corporation Commission, Bureau of Insurance.
How it works in VirginiaWashington
Runs its own external review through Washington State Office of the Insurance Commissioner.
How it works in WashingtonWest Virginia
Runs its own external review through West Virginia Offices of the Insurance Commissioner.
How it works in West VirginiaWisconsin
Defaults to the federal HHS-administered process (MAXIMUS).
How it works in WisconsinWyoming
Runs its own external review through Wyoming Department of Insurance.
How it works in WyomingEvery state — who runs your review
Whether your state runs its own external-review program or defaults to the federal HHS process. States with an in-depth guide are linked; the rest show the process that governs there.
- ALAlabamaFederal HHS
- AKAlaskaState program
- AZArizonaState program
- ARArkansasState program
- CACaliforniaState program
- COColoradoState program
- CTConnecticutState program
- DEDelawareState program
- DCDistrict of ColumbiaState program
- FLFloridaFederal HHS
- GAGeorgiaFederal HHS
- HIHawaiiState program
- IDIdahoState program
- ILIllinoisState program
- INIndianaState program
- IAIowaState program
- KSKansasState program
- KYKentuckyState program
- LALouisianaState program
- MEMaineState program
- MDMarylandState program
- MAMassachusettsState program
- MIMichiganState program
- MNMinnesotaState program
- MSMississippiState program
- MOMissouriState program
- MTMontanaState program
- NENebraskaState program
- NVNevadaState program
- NHNew HampshireState program
- NJNew JerseyState program
- NMNew MexicoState program
- NYNew YorkState program
- NCNorth CarolinaState program
- NDNorth DakotaState program
- OHOhioState program
- OKOklahomaState program
- OROregonState program
- PAPennsylvaniaState program
- RIRhode IslandState program
- SCSouth CarolinaState program
- SDSouth DakotaState program
- TNTennesseeState program
- TXTexasFederal HHS
- UTUtahState program
- VTVermontState program
- VAVirginiaState program
- WAWashingtonState program
- WVWest VirginiaState program
- WIWisconsinFederal HHS
- WYWyomingState program
For a state without a full guide yet: external review is requested through your state insurance department (state program) or through HHS / MAXIMUS (federal process), generally within four months of the final internal denial. We don't list a filing URL we haven't verified.
Before external review
Build the internal appeal first.
External review usually opens only after internal appeals are exhausted. Upload a denied EOB and Merits builds that internal appeal — cited to the rule and timed to your plan's deadline.