DIR Reduces Fees for Independent Medical Review, Independent Bill Review

The Department of Industrial Relations (DIR) is pleased to announce a reduction in Independent Medical Review and Independent Bill Review fees effective January 1, 2015.

IMR Fees

Any IMR application submitted on or after January 1, 2015 will be subject to the following fee schedule:

Standard IMRs Involving Non-Pharmacy Claims*

• Fee effective April 1, 2014: $420 per IMR
• Fee effective Jan. 1, 2015: $390 per IMR

Standard IMRs Involving Pharmacy Only Claims**

• Fee effective April 1, 2014: $390 per IMR
• Fee effective Jan. 1, 2015: $345 per IMR

IMRs Terminated or Dismissed Not Forwarded to a Medical Professional Reviewer:

• Fee effective April 1, 2014: $160 per IMR
• Fee effective Jan. 1, 2015: $123 per IMR

IBR Fees

Any IBR application submitted on or after January 1, 2015 will be subject to the following fee schedule:

Completed IBR

Fee effective April 1, 2014: $250 per IBR
Fee effective Jan. 1, 2015: $195 per IBR

Ineligible IBR Not Sent to Review***

Fee effective April 1, 2014: $50 per IBR
Fee effective Jan. 1, 2015: $47.50 per IBR

* A “non-pharmacy-only” IMR is an IMR where not all treatments in dispute fall under the service category, “pharmaceuticals.”

** A “pharmacy-only” IMR is an IMR where all treatments in dispute fall under the service category “pharmaceuticals.”

*** Sending an IBR to review means assigning and providing the complete file to a certified coding specialist with the expertise necessary to evaluate and render decisions on all line items in dispute.

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