Independent Review Entity (IRE) Transparency Initiative

Plans are continuously looking for data to better understand their appeals outcome.  The IRE transparency initiative provides plans with several more tools. During the CMS Fall Conference held on November 7, 2019,  CMS reviewed the Parts C and D Independent Review Entity (IRE) transparency initiatives planned for 2020.The initiatives include enhanced data reporting and a new public website database.

Enhanced Data Reporting

The enhanced reporting will include a Quarterly Enhanced Fact Sheet and a Plan Semi-Annual Report.  CMS expects plans to use this data to more proactively monitor their appeals data as well as to benchmark their outcomes against other plans.

These reports can be used to enhance plans oversight/monitoring by having a snapshot of category of overturn and priority level as well as issues and timeliness.  In addition, the report will allow plans  to see trended data over a period of time that may not be identified through internal monitoring.

New Public Website Database

Also, as part of this transparency initiative, MAXIMUS will host a public data website that will feature all Part C and Part D appeals decision rationales in a searchable format. This will give plans more insight into decisions made by the IRE which should in turn inform the plan’s decision-making.

Request Your Plan’s Reports

As a reminder, to begin receiving these reports you will need to request them before 1/1/20.