Independent Review Organization (IRO) for PRIRA reviews
Ended State & local contract Michigan Awarded
- Contract number
- MA230000000506
- Awardee
- MAXIMUS Federal Services, Inc.
- Contracting organization
- Department of Insurance and Financial Service
Contract facts
- Cumulative value
- $120,000
- End date
- Points of contact
-
- Joseph Stoddard stoddardj6@michigan.gov (517) 730-8761
- Drew Simon simond13@michigan.gov (517) 930-7725
- Darcie Payne payned3@michigan.gov (517) 930-9402
- Jeffrey Hayden haydenj3@michigan.gov (517) 230-2393
- Sarah Wohlford wohlfords@michigan.gov (517) 284-8743
Contract details come from michigan.gov. Updated .
About this contract
This indefinite delivery vehicle establishes an approved Independent Review Organization (IRO) to conduct external reviews under Michigan's Patient's Right to Independent Review Act (PRIRA). The contract authorizes Maximus Federal Services, Inc. to provide independent medical review services, including evaluations of health carrier denials and adverse determinations by qualified clinical peer reviewers. Services available under this IDV include standard reviews, expedited reviews, and experimental/investigational reviews, all delivered on a flat-fee, all-inclusive basis that encompasses labor, materials, and all associated deliverables. The IRO is responsible for making recommendations to the Department of Insurance and Financial Services Director regarding whether adverse determinations should be upheld or reversed, while maintaining compliance with PRIRA's minimum standards, including URAC accreditation, qualified clinical peer reviewer requirements, conflict-of-interest management, and strict confidentiality protocols.
The prime contractor for this IDV is MAXIMUS Federal Services, Inc., a Virginia corporation, with the Department of Insurance and Financial Services serving as the contracting organization. The contract was awarded on March 1, 2023, with an initial performance period through February 28, 2026. Change Notice Number 2 exercised the first two-year extension option, extending the contract through February 28, 2028, with three additional two-year renewal options available at the State's sole discretion. This IDV covers the state of Michigan and is structured as a firm fixed-price contract with an estimated aggregate value of $120,000.00, with pricing established at $545.00 for standard reviews, $675.00 for expedited reviews, and $635.00 for experimental/investigational reviews.
Files
| File | Type | Posted |
|---|---|---|
| 230000000506.pdf |
Quick answers
Who holds contract MA230000000506?
Contract MA230000000506 was awarded to MAXIMUS Federal Services, Inc. by Department of Insurance and Financial Service in Michigan on March 1, 2023.
How much is contract MA230000000506 worth?
Its cumulative value is $120,000.
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