Independent Medical Review Information
Please use the links below to access information.
Independent Medical Review - An Overview for the
Provider
How quickly are IMR decisions made?
The types of disputes eligible for IMR
Services considered Experimental or Investigational
Disputes concerning Medical Necessity of services
Reimbursement for Emergency or Urgent Care
Eligibility for an IMR
The Application - Provider's Role
Physician Certification Form
The Review Process
Independent Medical Review Organizations
Selection of Reviewers
Criteria for decision-making in Experimental or Investigational IMRs
Criteria for decision-making in Medical Necessity IMRs
The IMR Determination and the DMHC "Adoption"
The Department of Managed Health Care's contracted review organizations
Links and Additional Information
If you have additional questions about the IMR process or suggestions about
this Web site or its contents, please send your comments to helpline@dmhc.ca.gov or call the
HMO Help Center at 1(888) HMO-2219 or 1(888) 466-2219.
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