View all news

MAXIMUS Offers Independent Review Services to Assist State Agencies, the Federal Government, Consumers and Health Plans


-Services Support New Federal Rules for Internal and External Appeal Rights for Patients under the Patient Protection and Affordable Care Act-

RESTON, Va.--(BUSINESS WIRE)--The United States Departments of Health and Human Services, Labor and the Treasury announced yesterday a new internal claims and appeals and external review process for group health plans under the Patient Protection and Affordable Care Act.

The new appeal rules transform the current highly variable health claims and appeals process into one that is more uniform and structured. External appeals will be a new requirement for many group health plans and insurance carriers, as consumers in new health plans in every state will now have the right to appeal decisions to an independent outside entity.

As the recognized industry leader for government-sponsored health care appeal programs at the state and federal level, MAXIMUS brings over twenty years of experience in providing independent reviews. Through its MAXIMUS Federal subsidiary, MAXIMUS operates health care appeal programs for over 35 state regulatory agencies, as well as the Centers for Medicare and Medicaid Services, the United States Office of Personnel Management and the Department of Defense TRICARE program.

“As an independent organization without any conflicts of interest, MAXIMUS stands ready to assist government agencies, employers, consumers and insurance carriers in meeting the requirements of this important government initiative,” commented MAXIMUS CEO Richard Montoni.

MAXIMUS provides specialized services through a blend of experienced full time staff and 600 additional professionals, including attorneys, physicians, pharmacists and other clinicians, who are expert in navigating the challenge and complexities of all forms of health care appeals. MAXIMUS is fully accredited by the Utilization Review Accreditation Commission as an independent review organization, and many of the Company's independent review programs are also ISO 9001:2008 certified. Since 1989, MAXIMUS has completed more than 800,000 health care appeals on a timely basis and under rigorous quality control standards.


MAXIMUS (NYSE:MMS) is a leading provider of government services worldwide and is devoted to providing health and human services program management and consulting services to its clients. The Company has more than 6,500 employees located in more than 220 offices in the United States, Canada, Australia, the United Kingdom, and Israel. Additionally, MAXIMUS is included in the Russell 2000 Index and the S&P SmallCap 600 Index.

Lisa Miles, 800-MAXIMUS x11637

Multimedia Files:

Categories: Press Releases
View all news