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
310-470-1491 (fax)
www.admere.com
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 5272 River Road
  Ste. 650
Bethesda, MD 20816
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. 550
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. 8 Neshaminy Interplex
Ste 207
Trevose, PA 19053
800-283-8196
215-352-7801 (fax)
www.nmrusa.com
Elaine Nace, Esq.
ext. 106
Permedion 350 Worthington Rd.
Ste. H
Westerville, OH
43082-8325
800-473-0802
614-895-6784 (fax)
www.permedion.com
Sue Butterfield
ext. 3428
Prest & Associates 2712 Marshall Court
Ste. 1
Madison, WI 53705
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