Description
The Maryland Insurance Administration (MIA) is seeking multiple Independent Review Organizations (IROs) to conduct external reviews of Carriers' Adverse Decisions and Grievance Decisions. The selected IROs will assist the MIA in reviewing complaints regarding health care services and determining whether the services are medically necessary. The IROs will be required to provide expert medical necessity reviews and prepare official final written determinations. The contract will be for a period of five years, with no option periods. The MIA intends to make up to three contract awards, with one primary contract and up to two backup contracts.
Key aspects of the job include:
• Conducting external reviews of Carriers' Adverse Decisions and Grievance Decisions
• Providing expert medical necessity reviews
• Preparing official final written determinations
• Ensuring the neutrality and objectivity of all Expert Reviewers
• Complying with Maryland law and regulations regarding IROs
• Providing a plan for ensuring the neutrality and objectivity of all Expert Reviewers
• Establishing procedures for selecting Expert Reviewers and conducting conflicts of interest checks