Appeals Workflow
Manage multi-level appeals from initial filing through ALJ hearings
1
Internal Review
Plan Medical Director reviews original denial
30 days standard / 72h expedited
2
External (IRO)
Independent Review Organization evaluation
45 days standard / 72h expedited
⚡
Expedited Appeal
Fast-track for urgent medical necessity
72 hours maximum
ALJ
ALJ Hearing
Administrative Law Judge if L2 upholds denial
90 days from L2 decision
Active Appeals
| Appeal ID | Original Denial | Member | Level | Days Open | Deadline | IRO | Status | Actions |
|---|
Appeal Detail
Select an appeal to view details
IRO Assignment
National IRO Partners, LLC
Case APL-2025-0034
AssignedDue Feb 10