IPRO is a URAC accredited External Independent Review Organization performing external appeal reviews for 17 states and the District of Columbia, as well as self-insured plans and health plan administrators. These external reviews are conducted when the insurer denies coverage for what the patient and provider deem to be a necessary service. Types of appeals include but are not limited to cases related to medical necessity, experimental/investigational treatments, out-of-network care, rare diseases, formulary medications and pharmacy requests.
Additionally, IPRO serves as a dispute resolution contractor in New York State, adjudicating between plans and providers regarding the reasonableness of out-of-network billings for Emergency Services and Surprise Bills.