Independent Review Organization (IRO) for PRIRA reviews
Ended State & local contract Michigan Awarded
- Contract number
- MA230000000499
- Awardee
- Roffe Enterprises Inc
- Contracting organization
- Department of Insurance and Financial Service
Contract facts
- Cumulative value
- $120,000
- End date
- Points of contact
-
- Darcie Payne payned3@michigan.gov (517) 930-9402
- Drew Simon simond13@michigan.gov (517) 930-7725
- Joseph Stoddard stoddardj6@michigan.gov (517) 730-8761
Contract details come from michigan.gov. Updated .
About this contract
The Department of Insurance and Financial Services (DIFS) established this indefinite delivery vehicle to procure independent review organization (IRO) services under Michigan's Patient's Right to Independent Review Act (PRIRA). The contract authorizes Roffe Enterprises Inc. (operating as HHC Group) to conduct external reviews of health plan benefit denials, evaluate medical necessity determinations, and provide clinical recommendations to the DIFS Director. Services are provided on a fee-for-service basis with tiered pricing: $525.00 for standard reviews, $650.00 for expedited reviews, and $525.00 for experimental or investigational reviews. The contractor must maintain URAC accreditation, employ qualified clinical peer reviewers meeting specific licensing and experience standards, implement conflict-of-interest screening procedures, and comply with statutory timeframe requirements for review completion.
The prime contractor for this IDV is Roffe Enterprises Inc. (HHC Group), a Maryland corporation, under contract with the Michigan Department of Insurance and Financial Services. The initial contract period runs from March 1, 2023, through February 28, 2026, with three additional two-year renewal options available at the State's discretion, providing a potential total contract duration of eight years. The estimated aggregate contract value is $120,000.00. This contract is governed by Michigan law and covers the entire state of Michigan. Payment is processed via electronic funds transfer on a net 45-day basis, with a 5% discount offered for payment within 15 days.
Files
| File | Type | Posted |
|---|---|---|
| 230000000499.pdf |
Quick answers
Who holds contract MA230000000499?
Contract MA230000000499 was awarded to Roffe Enterprises Inc by Department of Insurance and Financial Service in Michigan on March 1, 2023.
How much is contract MA230000000499 worth?
Its cumulative value is $120,000.
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