Full URAC Accreditation
Independent Review Organization (IRO)

EXTERNAL REVIEW PROCESS

NATIONAL

NMR has full accreditation from URAC as an Independent Review Organization – Comprehensive Review (both Internal & External). NMR is able to provide Independent External Review services under the Federal Affordable Care Act.

Our clients include Insurance Companies, Third Party Administrators, Large Self-Funded Employers, as well as Taft Hartley Plans.

Technical Release No. 2010-02 | U.S. Department of Labor (dol.gov)

STATE BY STATE

NMR maintains Accreditations / Certifications in the states listed below.

Even if you don’t see your state listed, please call us at 1-800-283-8196 to see how we can partner.

State Certifications/Contracts:

 

State Department Certification / Contract Certified Since
Arizona Department of Insurance Independent Review Organization 2017
Arkansas Insurance Department Independent Review Organization 2010
Colorado Department of Regulatory Agencies Independent External Review Entity 2000
Connecticut Insurance Department External Appeal Entity 2009
Delaware Department of Insurance Independent Utilization Review Organization 2018
Georgia Department of Community Health Independent Review Organization 2017
Idaho Department of Insurance Independent Review Organization 2010
Illinois Department of Insurance Independent Review Organization 2010
Indiana Department of Insurance Independent Review Organization 2000
Kentucky Department of Insurance Independent Review Entity 2007
Louisiana Department of Health Independent Review Organization 2019
Louisiana Department of Insurance Independent Review Organization 2020
Maine Department of Professional and Financial Regulation Independent Review Organization 2014
Maryland Maryland Insurance Administration Private Review Agent 2020
Montana Commissioner of Securities and Insurance Independent Review Organization 2016
Nebraska Department of Insurance Independent Review Organization 2014
Nevada Division of Insurance External Review Organization 2011
New Hampshire Insurance Department Independent Review Organization 2019
New Hampshire Insurance Department Independent Review Organization Long Term Care 2019
New Mexico Superintendent of Insurance Independent Review Organization 2019
New York Department of Civil Service Dispute Resolution Program 2011
North Carolina Department of Insurance Independent Review Organization 2013
North Dakota Insurance Department Independent Review Organization 2018
Ohio Department of Insurance Independent Review Organization* 2000
Oklahoma Insurance Department Independent Review Organization 2013
Pennsylvania Department of Health Certified Utilization Review Entity as UR Agent for MCOs 1999
Pennsylvania Department of Health Certified Utilization Review Entity for Independent External Reviews 1999
Pennsylvania Insurance Department Independent Review Organization Long Term Care 2011
Pennsylvania Insurance Department Independent Review Organization 2024
South Carolina Department of Insurance Independent Review Organization 2019
South Dakota Division of Insurance Independent Review Organization 2010
South Dakota Division of Insurance Independent Review Organization Long Term Care 2010
Tennessee Department of Commerce and Insurance External Review Organization 2019
Utah Insurance Department Independent Review Organization 2011
Vermont Department of Financial Regulation Independent External Review Organization 2011
Vermont Department of Financial Regulation Independent Review of Long Term Care Benefit Trigger Determinations 2011
Virginia Bureau of Insurance Independent Review Organization 2011
Washington Office of the Insurance Commissioner Independent Review Organization 2005
Wisconsin Commissioner of Insurance Independent Review Organization 2009
Wyoming Department of Health Independent Review Organization 2010

*d/b/a as Ohio Independent Review Organization

Client Testimonials

  • Appeals Specialist

    NMR goes above and beyond to deliver top quality work. I really value their time and effort they put into each case and appreciate their friendly staff reaching out to me with any questions or concerns. All my cases have been returned in a timely manner, which is of great importance to me.




    Appeals Specialist
  • Supervisor, Clinical Appeals Operations
    Our company’s experience with NMR has been nothing short of remarkable. NMR offers an extensive panel of Specialty Physicians, quick turn-around-times, and detailed, quality reports. NMR is our “go-to” for uncommon specialty reviews. They regularly meet or exceed deadlines, and with superior quality results. What’s also nice is, their portal is user friendly and can be personalized to meet business needs. Above all, NMR’s staff and support are exceptional! They are readily available and responsive to questions/comments in a timely fashion. NMR offers innovative solutions for associated business challenges, and they are very accommodating to unique processes. No ask is too big or too small! We truly value our business relationship with NMR and the exceptional service they provide!
    Supervisor, Clinical Appeals Operations
  • Manager Appeals and Grievances

    It has been amazing working with the NMR team. They are fully transparent in how they can help meet State and Federal requirements and always maintains an open line of communication. Exceptional customer service and a pleasure to work with. Highly recommend!




    Manager Appeals and Grievances

CERTIFICATIONS

National Medical Reviews is an Independent Internal and External Medical Review Organization with URAC Accreditation. National Medical Reviews is certified by the Departments of Health & Human Services, Treasury & Labor as an Independent Dispute Resolution Entity.

Since 1996 NMR has been serving:

ERISA Regulated Benefit Plans ♦ Federally Regulated Agencies ♦ HMO ♦ Health Care Facilities ♦ State Agencies ♦ Insurance Companies ♦ Medicaid ♦ Medicare ♦ PPO ♦ PBMs ♦ Self-funded Plans ♦ State Insurance Departments ♦ Third Party Administrators ♦ Utilization Management Companies ♦ Workers Compensation