The IMR Determination and The DMHC "Adoption"

In addition to a summary of the case, the reviewers' determinations are provided to the Department, the enrollee, plan and any involved providers.

Through the HMO Help Center, the DMHC is required to immediately adopt the determination of the independent medical review organization, and to promptly issue a written decision to the parties that are binding on the plan. If the plan decision is overturned or modified by the IMR decision adopted by the DMHC, the health plan is required to promptly implement the decision. In the case of reimbursement for services already rendered, the health plan is required to reimburse the provider or enrollee within five working days. Significant financial penalties accrue if the plan fails to comply with an adopted IMR decision.