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External Peer Review

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 all types of health plans, third party administrators and state departments of insurance for member appeals, 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.

In accordance with URAC's most recent standards and as part of the IRO Agreement for Review Services, CIMRO provides each new client with a CIMRO Organizational Conflict of Interest Attestation affirming that no organizational conflict of interest exists at the time of contract execution. The attestation further defines the steps that CIMRO will take to assure no conflict of interest with the selected external peer reviewer.

To request an Agreement for Review Services and to discuss our competitive pricing structure, call Cindy Scopel at 800.635.9407 ext. 4201, or email at cscopel@cimro.com

 
 
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