pa-56-28-993: Independent review organization fee schedules; notice 2026-10 (Part II)

Summary

As required by section 2164.13 of Act 146 of 2022 (Act 146), the Insurance Department (Department) is publishing the fees charged by Independent Review Organizations (IRO) to insurers and Medical Assistance and CHIP Managed Care Organizations for conducting independent external reviews of adverse benefit determinations and grievances. The Department is charged with approving IROs that meet certain statutory criteria. An approval is valid for 2 years unless an IRO no longer satisfies the minimum statutory requirements or is no longer accredited. The Department may decline to certify an IRO if its fees are determined to be unreasonable or uncustomary in accordance with section 2169.9(d) of Act 146. The following organizations are currently approved by the Department. Questions regarding this notice may be directed to the Bureau of Health Coverage Access, Administration, and Appeals, RA-INHCA3@pa.gov, (717) 787-4192 or toll-free at (888) 466-2787. Standard IRO Fees Standard Independent External Review Fees Standard Medicaid/ CHIP Standard Commercial Insurance Standard Experimental Investigational Withdrawn Cancelled Reconsideration Additional Fees BHM Healthcare Solutions, Inc. $850 $850 $850 $200 Christopher Place Health Care Review $1,400 $1,800 $300* X Dane Street, LLC $600 $600 Emperion, d/b/a Medical Consultants Network (MCN) $675 $675 HealthCare Quality Strategies, Inc. $636 $636 $50 Island Peer Review Organization (IPRO) $700 $750 $700 Keystone Peer Review...

The agency’s own summary, as published.