Montana Independent Medical Review Form is a document used by the Montana Department of Public Health and Human Services (DP HHS) to evaluate medical claims submitted by health care providers. It is used to determine the appropriateness of proposed medical treatments and to ensure that quality medical care is provided. There are two types of Montana Independent Medical Review Form: the Pre-Approval Request form and the Post-Approval Request form. The Pre-Approval Request form is used by health care providers to seek approval for medical treatments before they are performed. The Post-Approval Request form is used by health care providers to request reimbursement for medical treatments after they have been provided. Both forms require detailed information about the proposed treatments and the patient's medical history.
Montana Independent Medical Review Form
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FAQ
What Is an Independent Medical Review? An Independent Medical Review (IMR) is a process in which expert independent medical professionals are selected to review specific medical decisions made by the insurance company.
Standard IMRs involving pharmacy and non-pharmacy claims: $345 per IMR. Expedited IMRs involving pharmacy and non-pharmacy claims: $345 per IMR. IMRs terminated or dismissed before forwarding to a medical professional reviewer: $115 per IMR.
WHAT IS AN IRO? Within the health care industry, an independent review organization (IRO) acts as a third-party medical review resource which provides objective, unbiased medical determinations that support effective decision making, based only on medical evidence.
Medical review companies provide services such as chart review, utilization review and appeals for either payers or hospital systems and healthcare providers.
Retrospective audits: Retrospective audits examine medical record documentation after the provider has submitted the claim to the insurance carrier and payment is received.
An IRO determines the medical necessity and appropriateness of health care delivered or proposed to be delivered by a health care provider. An IRO is responsible for assigning the case to an appropriate specialty reviewer who must certify they have no conflict of interest.