About the Independent Review Organization (IRO) for the Maryland Department of Health and Mental Hygiene (DHMH)

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On behalf of the Maryland Department of Health and Mental Hygiene (DHMH), Office of Health Services, MAXIMUS Federal Services serves as the Independent Review Organization (IRO), providing medical necessity case review of services delivered by a health care provider to a Maryland Medicaid beneficiary enrolled with and reimbursed by a Maryland Medicaid Managed Care Organization (MCO).

Before the IRO conducts a medical necessity case review, the provider must go through the full appeals process provided by the MCO.

In accordance with the Code of Maryland Regulations (COMAR) 10.09.71.03, Maryland Medical Managed Care Organizations (MCOs) are required to have a provider appeal process to resolve provider complaints, including claim denials, because the services were considered not medically necessary by the MCO.

The MCO appeals process was previously the provider's only recourse in overturning an MCO claims denial other than to litigate the case through the courts. As a result of Provider's requests, the Maryland Department of Health and Mental Hygiene (DHMH) has established this new process with an IRO, as means for Providers to receive an independent review of these medical necessity denials.

About MAXIMUS

MAXIMUS Federal Services is part of MAXIMUS, sharing a single focus on Helping Government Serve the People® since 1975. We are a large successful partner with a deep understanding of federal and state processes and programs, providing operations and program support to help the federal and state government serve constituents with better outcomes.

MAXIMUS applies our award-winning business process management (BPM) expertise and innovation to government requirements in a systematic methodology, resulting in cost-effective solutions that connect citizens more effectively with services. We are technology independent, financially stable and dedicated solely to government program success.

Contact

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MAXIMUS In Maryland:

MAXIMUS Federal Services
7275 Windsor Blvd, Suite 129
Milford, MD 21244

(443) 729-2947


mdirosupport@maximus.com

Useful Links

Maryland Department of Health and Mental Hygiene

MAXIMUS Federal Services