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| | California DIR Reduces Fees for Independent Medical Review, Independent Bill Review
By CA Dept of Industrial Relations Press Release - February 25, 2015
The Department of Industrial Relations (DIR) is pleased to announce a reduction in Independent Medical Review and Independent Bill Review fees effective January 1, 2015.
IMR Fees
Any IMR application submitted on or after January 1, 2015 will be subject to the following fee schedule:
Standard IMRs Involving Non-Pharmacy Claims*
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Fee effective April 1, 2014: $420 per IMR
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Fee effective Jan. 1, 2015: $390 per IMR
Standard IMRs Involving Pharmacy Only Claims**
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Fee effective April 1, 2014: $390 per IMR
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Fee effective Jan. 1, 2015: $345 per IMR
IMRs Terminated or Dismissed Not Forwarded to a Medical Professional Reviewer:
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Fee effective April 1, 2014: $160 per IMR
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Fee effective Jan. 1, 2015: $123 per IMR
IBR Fees
Any IBR application submitted on or after January 1, 2015 will be subject to the following fee schedule:
Completed IBR
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Fee effective April 1, 2014: $250 per IBR
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Fee effective Jan. 1, 2015: $195 per IBR
Ineligible IBR Not Sent to Review***
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Fee effective April 1, 2014: $50 per IBR
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Fee effective Jan. 1, 2015: $47.50 per IBR
* A “non-pharmacy-only” IMR is an IMR where not all treatments in dispute fall under the service category, “pharmaceuticals.”
** A “pharmacy-only” IMR is an IMR where all treatments in dispute fall under the service category “pharmaceuticals.”
*** Sending an IBR to review means assigning and providing the complete file to a certified coding specialist with the expertise necessary to evaluate and render decisions on all line items in dispute.
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