Texas Health and Human Services Commission
State AgencyTX
Posted
Nov 14, 2023
Oct 31, 2026
Independent Review Organization Services
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.