Independent External Review

Positively impacts the process and outcome of patient care through objective, clinically driven determination on medical necessity for appeals

American Health’s Independent External Review is designed to assist in compliance with the Patient Protection and Affordable Care Act (PPACA) by providing administration and management of final medical necessity determination conducted by URAC-accredited Independent Review Organizations (IRO). Through objective, clinically driven determination on medical necessity for appeals and ensuring impartiality of the assignment process, Independent External Review postively impacts the process and outcome of patient care.

American Health hosted a highly informative webinar about the much anticipated health care reform regulations that became effective September 23, 2010. According to the new regulations, and as detailed in our FAQs on external reviews and appeals, all non-grandfathered plans not subject to existing State external review requirements must now appoint three URAC-accredited Independent Review Organizations (IRO).

Our Independent External Review program responds quickly to claimant requests for expedited appeals and provides the needed flexibility to assist plans in meeting the PPACA requirements. The program serves as the source of three URAC-accredited IRO contracts and manages the assignment and tracking process for external appeals.

• Single source for administration and management of external appeals to URAC-accredited IROs
• Expedited process for urgent claims
• Objective external appeals and impartial assignment processes allow optimum patient care

If you missed attending our webinar and want to learn more about the new regulations and what they mean to health plan design, you can replay a recorded version. To learn more about American Health's Independent External Review program, please call us at (866) 614-4244 or send an email to marketing@AHHinc.com.