Open Enrollment for Independent Review Organization Services, Medicaid & CHIP Services, Medical & UR Appeals

The Texas Health and Human Services Commission (HHSC) is seeking applications to establish contracts for Independent Review Organizations (IROs) to assist HHSC Medical and UR Appeals (M&URA) and HHSC Operations Management (OM) Provider Resolution and Administrative Appeals (PRAA) with conducting appeal reviews. The selected IROs will provide independent review services for Medicaid and CHIP services, medical and UR appeals. The contract term will be for 3 years, with an option to extend for up to 1 year. • The IROs will be responsible for conducting appeal reviews of adverse decisions denying payment for certain health care services. • The IROs will provide independent review services for Medicaid and CHIP services, medical and UR appeals. • The contract term will be for 3 years, with an option to extend for up to 1 year. • The selected IROs will be required to meet the minimum qualifications and requirements specified in the Open Enrollment document.