Independent Review Organization Services

The Vendor is required to provide for the services of an Independent Review Organization (“IRO”) to conduct reviews of claims.
- Independent Review Organization (“IRO”) to provide the following services:
• Conduct an independent review of denied medical claim, taking into consideration all information provided.
• Perform reviews addressing both medical necessity and diagnosis-related group (“DRG”) reassignment.
• Complete the review and issue a determination within sixty (60) days after agency upstate submits the claim for review.
- The main document for this are not accessible on our website. Kindly reach out to the contact person listed in this document for more details.