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External Review |
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| Unit’s Major Areas of Responsibility: |
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The purpose of the Healthcare Review (HCR) Unit is to provide for the independent medical review of health plan coverage denials that North Carolina law grants our citizens. HCR’s primary responsibility is to receive and process requests for external review and assign accepted cases to contracted independent review organizations (IROs). HCR contracts with and oversees the IROs who perform the reviews.
HCR is also responsible for providing counseling to consumers regarding appeals to their health plan (i.e. "internal appeals").
Unit staff answers questions from consumers, physicians, hospital representatives, insurers, agents and other DOI Divisions and staff regarding consumer appeals to health insurers as well as the external review process provided through DOI.
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