San Francisco, CA – The California Department of Industrial Relations (DIR) recently announced a reduction in Independent Medical Review and Independent Bill Review fees effective April 1, 2014.
These new fees represent a 25 percent reduction. Parties who submitted an IMR or IBR on or after April 1, 2014 will receive a refund in the amount of fees paid in excess of the new fee schedule.
IMR Fees
Any IMR application submitted on or after April 1, 2014 will be subject to the following fee schedule:
- Standard IMRs Involving Non-Pharmacy Claims*
Previous Fee: $560 per IMR
Fee Effective April 1, 2014: $420 per IMR - Expedited IMRs Involving Non-Pharmacy Claims
Previous Fee: $685 per IMR
Fee Effective April 1, 2014: $515 per IMR - Standard IMRs Involving Pharmacy Only Claims**
Previous Fee: Not Applicable
Fee Effective April 1, 2014: $390 per IMRs - IMRs Terminated or Dismissed Not Forwarded to a Medical Professional Reviewer:
Previous Fee: $215 per IMR
Fee Effective April 1, 2014: $160 per IMR - IMRs Terminated or Dismissed After Case Forwarded to a Medical Professional Reviewer:
Previous Fee: $560 per IMR
Fee Effective April 1, 2014: $420 per IMR
IBR Fees
Any IBR application submitted on or after April 1, 2014 will be subject to the following fee schedule.
- Completed IBR
Previous Fee: $335 per IBR
Fee Effective April 1, 2014: $250 per IBR - Terminated IBR Not Sent to Review***
Previous Fee: $65 per IBR
Fee Effective April 1, 2014: $50 per IBR
* A “non-pharmacy-only” IMR is an IMR where not all treatments in dispute fall under the service category, “pharmaceuticals.”
** A “pharmacy-only” IMR is an IMR where all treatments in dispute fall under the service category “pharmaceuticals.”
*** Sending an IBR to review means assigning and providing the complete file to a certified coding specialist with the expertise necessary to evaluate and render decisions on all line items in dispute.
Source: CA DIR