Independent External Review
Ensuring appropriate care and compliance with health care reform
American Health’s Independent External Review, also known as Third-Level Appeals, is designed to help plans comply with the Patient Protection and
Affordable Care Act (PPACA) by providing administration and management of final medical necessity determinations by URAC-accredited Independent Review
Organizations (IROs). Our program allows clients to respond quickly to claimant requests for expedited appeals while providing a thorough, structured
process that meets all PPACA requirements.
Independent External Review serves as the source of three URAC-accredited IRO contracts and manages the assignment and tracking process for external appeals. Through objective, clinically driven determination of medical necessity for appeals and ensuring impartiality of the assignment process, the program positively impacts the process and outcome of patient care.
Independent External Review allows the client to outsource the management of the process for obtaining independent external reviews. It provides an efficient, cost-effective solution to internal administration of adverse determinations while ensuring compliance.
Product Highlights
- Single source for administration and management of external appeals to URAC-accredited IROs
- Expedited process for urgent reviews
- Objective external appeals and impartial assignment processes allow optimum patient care
