Independent Review Organizations Certified to
Perform Independent Reviews in Wisconsin

Wisconsin's independent review process may help you resolve some disputes with your health plan regarding its coverage denial. This process allows you to have a medical expert with no connection to your health plan review the health plan's decision. An independent review is available whenever your health plan denies you coverage because it maintains that the treatment is not medically necessary or appropriate or that the treatment is experimental or investigational. You may also request an independent review if your health plan denies coverage based on a preexisting condition exclusion or if it rescinds your health insurance policy or certificate.

Both state and federal law give individuals the right to request an independent external review of some of their health plan's decisions. If your health plan is required to follow the federal law, it is not limited to using the Wisconsin-certified IROs listed below.

The Fact Sheet on the Independent Review Process in Wisconsin provides more information about this process. It can be found at http://oci.wi.gov/pub_list/pi-203.htm. You can also contact OCI at the address on the How to Contact Us page to request a copy.

A copy of the listing of organizations certified is available in p d f format for printing at: http://oci.wi.gov/iroscert.pdf (opens in new window). Note: You will need an Adobe Acrobat Reader to view or print pdf version, which you can download at no cost from Adobe .

The following organizations, listed in alphabetical order, have been certified as IROs in Wisconsin:

NameAddressPhone/Fax/Web AddressContact
Advanced Medical Reviews 10780 Santa Monica
  Blvd., Ste 333
Los Angeles, CA
90025-4779
800-726-1207
310-765-6261 (fax)
www.admere.com
AMR Account Services Dept.
or
Caitlin Harker
IPRO 1979 Marcus Ave.
Lake Success, NY
11042-1002
800-227-3143
516-304-3760 (fax)
www.ipro.org
Terese Giorgio
ext. 223
MAXIMUS - Center for Health Dispute Resolution State Appeals
3750 Monroe Ave.
  Ste. 705
Pittsford, NY
14534-1302
866-763-6395
585-425-5296 (fax)
www.healthappeal.com
Lisa Maguire, Esq.
(585) 348-3119
or
Ronna Marsh
(585) 348-3122

Cover page should specify: Not a Medicare Appeal
MCMC LLC 1451 Rockville Pike
  Ste. 440
Rockville, MD 20852
888-313-6267
301-652-1250 (fax)
www.mcmcllc.com
Joelle Georges
301-652-1818
Medical Consultants Network, Inc. 901 Boren Ave.
  Ste. 1400
Seattle, WA 98104
800-636-3926
206-623-4956 (fax)
www.mcn.com
Erik Halse
ext. 2206
Medical Review Institute of America 2875 S. Decker Lake
  Dr., Ste. 300
PO Box 25547
Salt Lake City, UT
84125-0547
800-654-2422
801-261-3189 (fax)
www.mrioa.com
Aja Ogzewalla
ext. 6475
National Medical Reviews, Inc. 260 Knowles Ave.
  Ste. 330
Southampton, PA 18966
800-283-8196
215-352-7801 (fax)
www.nmrusa.com
Elaine Nace, Esq.
ext. 106
Prest & Associates 401 Charmany Dr.
  Ste. 305
Madison, WI 53719
800-358-5129
608-232-9929 (fax)
www.prestmds.com
Susan Prest

Your health plan should provide you with information on your right to request an independent review in its written materials. You can also call the health plan at its toll-free number and request information on independent review.

Independent Review Annual Reports
Independent Review Process Minimum Adjusted Dollar Amount

Further questions may be directed to: ocihmo@wisconsin.gov