Federal and Postal Employee Health Benefit Independent Medical Review

The contractor will provide medical and dental health benefits reviews of disputed claims and preservice requests (prior approval, prior authorization or precertification), consultation services, and special projects. The Office of Personnel Management (OPM) will determine the medical specialist category for each disputed claim and the Contractor will assign a medical specialist (Coding Specialist, M.D., D.O., D.D.S., or D.M.D.) appropriate for each disputed claim.

The medical specialist will review the available case documentation for different categories of disputed medical services and will provide the Government a typewritten review analyses resulting from the evaluation of the case file in addition to a paper or electronic copy of all references cited in support of the analyses.