Welcome to the Illinois Department of Insurance
External Review Response Center
SSL(HTTPS) encryption of the transmission is used to secure the communication.
Use this secure facility to:
Send Official Response to an external review request or assignment (Attach multiple documents as needed)
Send acknowledgment, quick note, or other short comments which don't require an attachment.
*All communications require DOI File Number, Requestor/Patient Name, Correspondence Type, and Sender Name and Phone
*DOI File Number:
*Type of Correspondence:
- Select type of correspondence -
- Items REQUIRING attachment
Carrier Eligibility Confirmation
Carrier Eligibility Denial
Carrier Conflict Statement
Additional Information from Carrier
IRO Conflict Statement
Additional Information from IRO
IRO Review Decision
Carrier Payment Information
- Items NOT requiring attachment
Acknowledgment from Carrier
Acknowledgment from IRO
Please give us your entity name, your name and your phone number, in case we have questions about your correspondence.
To receive an email summarizing your communication, please provide an email address.
Check this box to remember your settings for subsequent visits to the site.
For communications not requiring an attached document, please enter appropriate information.
Please attach information (on company letterhead) and supporting documentation below.
(Please use common file formats: PDF, Word, Excel, TIF, and
NOT PASSWORD PROTECTED
To attach files, click the 'Browse' button, select the file to attach, then press the 'Attach File' button.
Each attached file must be less than 4MB. Total size of all attachments should not exceed 19MB.
To remove an attached file, click the 'Delete' link next to the attachment name.
Copyright © 2017
Illinois Privacy Information