Review Entity definition
Examples of Review Entity in a sentence
Subsequent Appeals for traditional Medicare A and B services will be automatically forwarded to the Medicare Independent Review Entity (IRE) by the Contractor.
The DURC Internal Review Entity (IRE) has determined that this research does not meet the DURC definition and that no additional review and oversight under the USG Policy for Institutional Oversight of DURC are required.
If the CMS Independent Review Entity decides in the Enrollee’s favor and reverses the Contractor’s decision, the Contractor must authorize the service under dispute within 72 hours from the date the Contractor receives the review entity’s notice reversing the Contractor’s decision, or provide the service under dispute as expeditiously as the Enrollee’s health condition requires, but no later than 14 calendar days from the date of the notice.
For expedited external Appeals, the CMS Independent Review Entity will send the Enrollee and the Contractor a letter with its decision within 72 hours after it receives the case from the Contractor, or at the end of up to a 14 calendar day extension.
For standard external Appeals, the CMS Independent Review Entity will send the Enrollee and the Contractor a letter with its decision within 30 calendar days after it receives the case from the Contractor, or at the end of up to a 14 calendar day extension.
If the CMS Independent Review Entity decides in the Enrollee’s favor, the Contractor must authorize or provide the service under dispute as expeditiously as the Enrollee’s health condition requires but no later than 72 hours from the date the Contractor receives the notice reversing the decision.
The MAO shall provide AHCCCS with the following information: A quarterly summary of Part C and Part D pre-service member appeals received and the outcomes of those appeals, A quarterly summary of Medicare Independent Review Entity (IRE) decisions received, and Service level detail on those appeals upheld and overturned (including a description of the action that was appealed).
MAO shall provide AHCCCS with the following information: • A quarterly summary of Part C and Part D pre-service member appeals received and the outcomes of those appeals; • A quarterly summary of Medicare Independent Review Entity (IRE) decisions received; and • Service level detail on those appeals upheld and overturned (including a description of the action that was appealed).
The CMS Independent Review Entity (IRE) If, on internal Appeal, the Contractor does not decide fully in the Enrollee’s favor within the relevant time frame, the Contractor shall automatically forward the case file regarding Medicare services to the CMS IRE for a new and impartial review.
Subsequent appeals for traditional Medicare A and B services will be automatically forwarded to the Medicare Independent Review Entity (IRE) by the Contractor.