Department of Insurance External Reviews
CIMRO is accredited by URAC as an Independent Review Organization (IRO) for External Review. External peer review services provide an unbiased independent review of denied health insurance claims.
These services are provided to state departments of insurance for member appeals of health care services that have exhausted the health plan's internal appeals processes, including denials due to:
Prior to accepting any case for external peer review, CIMRO ensures that there is no organizational conflict of interest and that no conflict of interest exists with the clinical peer reviewer selected to conduct the review.
External peer reviews are conducted in accordance with federal and applicable state specific regulations.
CIMRO's pricing structure is established with the state departments of insurance during the application process. Health plans are provided with pricing information at the time of the review.
These services are provided to state departments of insurance for member appeals of health care services that have exhausted the health plan's internal appeals processes, including denials due to:
- Medical necessity
- Experimental/investigational
- Pre-existing condition/rescission of health coverage
Prior to accepting any case for external peer review, CIMRO ensures that there is no organizational conflict of interest and that no conflict of interest exists with the clinical peer reviewer selected to conduct the review.
External peer reviews are conducted in accordance with federal and applicable state specific regulations.
CIMRO's pricing structure is established with the state departments of insurance during the application process. Health plans are provided with pricing information at the time of the review.