Independent Review Organization. (a) When an appeal is referred to an independent review organization, within ten (10) days of receipt of the request for appeal from the plan administrator, the independent review organization shall conduct a preliminary review of the appeal and accept it for full review if it determines that:
Independent Review Organization. “IRO”) Rights Preserved. Nothing herein, or in any clinical review criteria, shall be construed to limit the right of a participant or beneficiary to seek an independent review of any denial of ABA and/or NDT for treatment of a Qualified Mental Health Condition to the extent that the participant or beneficiary has that right under the Plan or the law. Defendants agree to comply with existing law regarding notification of participants and beneficiaries in any denial of coverage for ABA and/or NDT for treatment of a Qualified Mental Health Condition of their appeal rights, including the right to seek an IRO to the extent that right exists under the Plan or the law.
Independent Review Organization. Within 90 days of the Effective Date, Olsten shall retain an independent review organization ("IRO"), such as an accounting, auditing, or consulting firm, to perform reviews of Olsten's billing and compliance practices. The reviews will be conducted annually and will cover the five consecutive years from August 1, 1999 through July 31, 2004. The IRO must have expertise in the billing, coding, reporting (including preparation of cost reports), and other requirements of Federal health care programs from which Olsten seeks reimbursement. The IRO shall produce a report for each engagement and the report will address every matter required by this CIA to be addressed in that engagement.
Independent Review Organization. Bevexxx xxxll retain an entity, such as an accounting, auditing or consulting firm (hereinafter "Independent Review Organization" or "IRO"), to perform review procedures to assist Bevexxx xxx the OIG in assessing the adequacy of Beverly's submissions to Federal health care programs and its compliance with this CIA. The IRO must be independent from Bevexxx xxx must have expertise in the billing, reporting and other requirements of the Federal health care programs from which Bevexxx xxxks reimbursement. The IRO must be retained to conduct the review of the first year (2000) within 120 days of the effective date of this CIA. The IRO shall produce a separate report for each engagement. The IRO will conduct two separate types of engagements. One will be an analysis of Beverly's claims submissions to the Federal health care programs to assist Bevexxx xxx OIG in determining compliance with all applicable statutes, regulations, and directives/guidance ("submissions engagement"). The submissions engagement will assess, in part, Beverly's internal audits, which are described below. The second engagement will determine whether Bevexxx xx in compliance with this CIA ("compliance engagement").
Independent Review Organization. As part of the compliance and medical quality assurance program, the Tribes have engaged an accounting firm (“Independent Review Organization” or “IRO”) to perform periodic reviews of the Tribes’ claims submissions. The IRO requirements are outlined in Appendix A.
Independent Review Organization
