Independent Review Organization Services

Description: Conduct external medical reviews (EMRs) for: texas medicaid managed care organization (MCO) or dental maintenance organization (DMO) benefit denials or reductions that are appealed by medicaid members or their authorized representatives and subsequently are requested for review by a contracted IRO; and eligibility decisions made by HHSC for a medicaid program in which eligibility is based on a medicaid applicant or recipient's medical or functional need.