Independent Review Organization (IRO) for PRIRA reviews
Ended State & local contract Michigan Awarded
- Contract number
- MA230000000505
- Awardee
- Physio Solutions LLC
- Contracting organization
- Department of Insurance and Financial Service
Contract facts
- Cumulative value
- $120,000
- End date
- Points of contact
-
- Sarah Wohlford wohlfords@michigan.gov (517) 284-8743
- Joseph Stoddard stoddardj6@michigan.gov (517) 730-8761
- Drew Simon simond13@michigan.gov (517) 930-7725
- Darcie Payne payned3@michigan.gov (517) 930-9402
Contract details come from michigan.gov. Updated .
About this contract
Physio Solutions LLC, operating as medlitix, provides Independent Review Organization (IRO) services under this indefinite delivery vehicle to conduct medical reviews pursuant to Michigan's Patient's Right to Independent Review Act (PRIRA). The contract authorizes medlitix to perform three primary service categories: standard benefit denial reviews, expedited reviews, and experimental or investigational procedure reviews, priced at $475.00, $575.00, and $475.00 per review respectively. As a prequalified IRO, the contractor evaluates health carrier benefit denials and submits written recommendations to the Michigan Department of Insurance and Financial Services Director regarding whether adverse determinations should be upheld or reversed. The contractor must maintain URAC accreditation, employ qualified clinical peer reviewers without conflicts of interest, and adhere to statutory timeframes of 14 days for standard reviews and 36 hours for expedited reviews.
The prime contractor, Physio Solutions LLC (Pennsylvania limited liability company), entered into this agreement with the Michigan Department of Insurance and Financial Services effective March 1, 2023. The initial three-year contract term expires February 28, 2026, with three optional two-year renewal periods available at the State's discretion; a recent change notice extended the contract through February 28, 2028. The contract is classified as a Department of Insurance and Financial Services state procurement agreement with an estimated aggregate value of $120,000.00 and firm pricing throughout the term. The contractor must maintain comprehensive insurance coverage, comply with all state data security and confidentiality requirements, and submit annual reports documenting review volumes, outcomes, and case types.
Files
| File | Type | Posted |
|---|---|---|
| 230000000505.pdf |
Quick answers
Who holds contract MA230000000505?
Contract MA230000000505 was awarded to Physio Solutions LLC by Department of Insurance and Financial Service in Michigan on March 1, 2023.
How much is contract MA230000000505 worth?
Its cumulative value is $120,000.
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