The Independent Review Organization (IRO) market was created to provide an independent third-party, medical oversight function for the health benefits industry. Insurance Carriers and Plans realized that a doctor directly on their payroll didn’t give the appearance of a fair and impartial decision, especially in light of the litigation that looms over every coverage decision. However, independent and vetted organizations, prepared and trained in providing impartial review, could function to verify good coverage decisions and protect the insured or plan member when needed. Gradually Departments of Insurance across the nation came to accept IROs as a means to ensure a fair process. Then ERISA updates introduced in 2000 added an endorsement for Independent Review. Finally, the ACA added its approval in the form of a mandate for Independent or External Review at the final level of appeal.
MCMC delivers the impartiality, clinical expertise, review process expertise and reassurance of compliance with state and federal laws that the health benefit industry requires.
So to stay in compliance, lower your risk of adverse litigation, assure fairness in the adjudication process and avoid abusive treatment or billing patterns, turn to MCMC.
“Let the Experts Take a Look.”™