PA| The Pennsylvania Insurance Department has published the 2025 fee schedules for Independent Review Organizations (IROs) conducting external reviews of adverse benefit determinations and grievances.
The rate categorizes fees as follows:
- Standard Independent External Review Fees: Base rates charged for external reviews, with categories for Medicaid/CHIP, Commercial Insurance, and Experimental/Investigational reviews.
- Expedited Independent External Review Fees: Rates for faster, expedited review cases in the same core categories as standard reviews.
- Withdrawn/Cancelled/Reconsideration Fees: Fees charged when cases are withdrawn, cancelled, or require reconsideration.
- Additional Fee Structures: Supplemental charges, such as page fees for large case files and extra charges for multiple-physician panel reviews or cases exceeding standard parameters.
