External Independent Third Party Review

Effective with denials issued by an MCO on and after January 1, 2020, providers are entitled to request an external independent third-party review (EITPR) of the MCO’s appeal decision. Providers must complete the MCO appeal process prior to requesting an EITPR. Providers may not request an EITPR for an MCO’s reconsideration decision. Members may not request an EITPR due to payment requirements.

External Independent 3rd Party Review