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 within 1 business day 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 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 of assigning 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 within 10 business days following the date of receipt of the notice, for the IRO’s consideration in its external review. The IRO may accept and consider additional information submitted after the 10 business days.