Independent External Review

Ensuring appropriate care and compliance with health care reform

Independent External Review 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


  • From a medical management standpoint, AHH delivers what the customer wants: Flexibility that fits our needs, versus one solution that fits all needs. Their onsite nurses are accustomed to our client base. They are invested in our success.
    David Reynolds
    President & CEO

    Capitol Administrators Rancho Cordova, CA
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    LaRea Albert

    Lonestar TPA Tyler, TX
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    Greg Cucullu

    Combined Benefit Administrators Fresno, CA
  • American Health Holding is always looking at ways to innovate and offers each client the opportunity to customize a program that fits their unique needs. Their specialized medical professionals combine compassion, patience and unique knowledge about health care navigation to support the member and plan from both a quality of care and cost perspective.
    Holly Weiske
    Director of Client Services

    Cypress Benefit Administrators Appleton, WI
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    Claims & Eligibility Manager

    National Automatic Sprinkler Industry Landover, MD