Government Contract | North Carolina
Independent Review Organizations to Perform Reviews of Health Plan Utilization Review Noncertifications

Bid Information

Bid Alert No: 00000456929

Bid Title: Independent Review Organizations to Perform Reviews of Health Plan Utilization Review Noncertifications

Agency Bid No. Title: 12-001102

Received Date: 01/11/2016

Close Date: 03/03/2016

Purchase Type: Not Stated

Delivery Point: Not Stated, North Carolina

Delivery Date: Not Stated

Special Notices: Questions Due By 01/22/2016 02:00 PM, Bidder Preregistration


Specifications include, but are not limited to:IROs are requested to perform a clinical review of contested insurer decisions to upholdtheir initial denial of coverage based on lack of medical necessity. In the case of anexpedited review, the expert clinical peer reviewers may be making the determination asto whether the requested service is medically necessary, experimental or investigationalfor the covered persons condition, or cosmetic, before the case is appealed internallywith the insurer.Specifically, the scope of service for the IRO is to: accept assignment of cases without the presence of organizational conflict of interest. have and maintain a comprehensive program for credentialing clinical peer reviewers. identify the relevant clinical issues of the case and the question to be asked of theexpert clinical peer reviewer. identify and assign a qualified and impartial expert clinical peer reviewer who is freefrom conflict and who meets the minimum qualifications of a clinical peer reviewer,to review the disputed case and render a decision regarding the appropriateness of thedenial for the requested treatment or service. issue determinations that are timely and complete, as defined in the statutoryrequirements for standard and expedited review.

Product Code: 95237

Agency Information

Issuing Agency: State of North Carolina-Department of Insurance

State: North Carolina

Agency Type: State and Local

Contact: Wendy Holland NC Department of Insurance, 430 North Salisbury Street, Room 4085C, Raleigh, North Carolina, 27603

Phone: 919-807-6038




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