Department of Insurance and Self Funded 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 or self funded/third party administrators 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 during the application or contracting process.
These services are provided to state departments of insurance or self funded/third party administrators 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 during the application or contracting process.