Common use of Assignment of an IRO Clause in Contracts

Assignment of an IRO. If the request is eligible for external review, The Plan will immediately assign an IRO on a random basis or using another method of assignment that ensures the independence and impartiality of the assignment process, from the list of approved IROs compiled and maintained by the Commissioner of Securities and Insurance, to conduct the external review. In making the assignment, The Plan will consider whether an IRO is qualified to conduct the particular expedited external review based on the nature of the health care service or treatment that is the subject of the adverse benefit determination or final internal adverse benefit determination and will also take into account other circumstances, including conflict of interest concerns. Within 1 business day after assignment of the IRO, The Plan will notify the Member or the Member’s authorized representative, in writing, that The Plan has initiated an external review and that the Member or the Member’s authorized representative may submit additional information to the IRO for the IRO’s consideration in its external review.