Independent Review Organization

Amalgamated Medical Care Management offers Independent Review Services for hospitals, health care systems and managed care organizations nationwide. These services support the full array of state and federal regulatory-mandated appeals in full compliance with URAC, as well as all “Patient Protection and Affordable Care Act” requirements.

A full scope of Independent Review services feature:

  • First level pre-certification/concurrent review
  • First and second level appeals
  • Expedited appeals
  • Retrospective services
  • Investigative/experimental assessments
  • Medical claims reviews including coding
  • Physician consultation
  • Quality of care assessments
  • Disability and Accidental Death and Dismemberment (AD&D) reviews
  • Pharmacy reviews
  • Accredited pursuant to URAC standards

Amalgamated’s IRO Services rely on a network of over 250 doctors in 70 different medical specialties; an important attribute when appeals occur and require the expertise of a specialist.