If an individual is eligible to appeal, a certified independent review organization made up of physicians and other healthcare professionals will review the case and medical records. Payers will be required to overturn denied claims if the review organization determines a service should have been covered, and all decisions are final.
Using the new website is free, and residents can expect a final decision within 45 days of submitting their request for review. Expedited reviews are also possible. The new process only applies to fully insured commercial plans, ACA plans or plans purchased directly from a payer.
