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.

In the past few weeks there have been numerous restrictions placed on businesses throughout the United States. Many states and localities across the country have enacted temporary restrictions on non-essential business operations, requiring millions of workers to stay home. Amalgamated Life Insurance Company, which is based in New York, is considered an essential business and therefore is not subject to these temporary restrictions.

However, in an effort to protect the health and safety of our employees, their families and communities, we have taken a series of company-wide actions, across all Amalgamated Family of Companies locations, to implement work from home and other flexible arrangements where feasible. Despite these changes, we will continue to provide you and your members with the customer service levels you have come to expect from us prior to the coronavirus outbreak.

We are diligently working with our partners and vendors to utilize our remote capabilities and infrastructure. We are also in constant communication with UPS and the USPS to stay informed of any potential changes in service. For the duration of this state of emergency, Amalgamated Life Insurance Company will comply with any required Notice Obligations by emailing and/or mailing notices to all consumers.

If you have any questions or concerns please reach out to your Amalgamated Family of Companies representative or our customer service center at: 914-367-5000. They are well-prepared to answer your questions and can address your specific needs.