Tip for Federal External Review

Federal external review applies when your state has not set up its own external review process

Tip for Federal External Review

The process and timelines are the same as state external review — 45 days standard, 72 hours expedited

Tip for Federal External Review

Contact the Department of Labor's Employee Benefits Security Administration (EBSA) at 1-866-444-3272 for help with ERISA plan appeals

Insurancehard

Federal External Review Request

Federal External Review · CMS / MAXIMUS Federal Services

HHS-administered Federal External Review for states without compliant external review processes. Filed through the CMS online portal at no cost to the consumer.

Form Details

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Where to Submit This Form

📬

Mail to the federally facilitated external review organization

For plans in states that have not established their own external review process, or for self-funded non-federal governmental plans.

🌐

Through the HHS external review portal

https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/external-review

File through the federal external review process.

Filing Deadline

4 months from the date of the final internal adverse benefit determination.

Required Attachments

📎 Copy of the final internal appeal denial
📎 All prior appeal documentation and medical records
📎 Additional clinical evidence supporting the request
📎 Completed federal external review request form

Processing Time

Standard: 45 days. Expedited: 72 hours for urgent cases involving serious jeopardy to health.

What Happens Next

A federally contracted IRO will review the case. The decision is binding on the plan. If overturned, the plan must comply promptly.

Tips for This Form

✓ Federal external review applies when your state has not set up its own external review process
✓ The process and timelines are the same as state external review — 45 days standard, 72 hours expedited
✓ Contact the Department of Labor's Employee Benefits Security Administration (EBSA) at 1-866-444-3272 for help with ERISA plan appeals
✓ The IRO reviewer must be a clinical peer in the relevant specialty

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