Life And Health Independent Review Organization Consulting Services

Background

The Maryland Insurance Administration (MIA) is issuing this Request for Proposals (RFP) to procure the services of multiple Independent Review Organizations (IRO) Contractors. The goal is to conduct external reviews of Carriers’ Adverse Decisions and Grievance Decisions as authorized under Subtitle 10A of Title 15 of the Insurance Article of the Annotated Code of Maryland. The MIA regulates the insurance industry in Maryland and seeks to ensure that consumers have access to fair and impartial reviews of health care service determinations.

Work Details

Contractors will be responsible for conducting independent medical necessity reviews of adverse and grievance decisions made by health care carriers. Specific tasks include: - Reviewing complaints regarding Adverse Decisions or Grievance Decisions, - Preparing official final written determinations, - Selecting Expert Reviewers who meet regulatory requirements, - Performing conflicts of interest checks, - Advising the MIA on determinations, - Ensuring timely communication with MIA staff. Contractors must also maintain a monthly log of determinations and ensure round-the-clock availability for emergency cases.

Period of Performance

The contract will have a base period of five years with no option periods.

Place of Performance

Services will be performed remotely, with potential requirements for in-person expert testimony at the offices of the MIA in Baltimore, Maryland.

Bidder Requirements

Offerors must have at least five years of experience in conducting independent medical necessity reviews for a State or Federal Agency. They must also be accredited by either the National Association of Independent Review Organizations (NAIRO) or the Utilization Review Accreditation Commission (URAC). Additionally, there is a Minority Business Enterprise (MBE) participation goal of 3% for this procurement.