IRO Clause Samples
The IRO (Independent Review Organization) clause establishes the requirement for disputes or specific issues to be reviewed and resolved by an impartial third-party expert or organization. In practice, this clause outlines the process for selecting the IRO, the scope of their review, and how their findings or decisions will be implemented by the parties involved. Its core function is to provide a neutral mechanism for resolving disagreements, thereby reducing bias and ensuring fair, expert-driven outcomes in complex or technical matters.
IRO. 010-2 R3.1. A mutually agreeable format X X Each The CAISO and TE shall each maintain compliance with this requirement with respect to its operations as identified in the operating procedure 3130 established by the CAISO. IRO-010-2 R3.2. A mutually agreeable process for resolving data conflicts X X Each The CAISO and TE shall each maintain compliance with this requirement with respect to its operations as identified in the operating procedure 3130 established by the CAISO. IRO-010-2 R3.3. A mutually agreeable security protocol X X Each The CAISO and TE shall each maintain compliance with this requirement with respect to its operations as identified in the operating procedure 3130 established by the CAISO. IRO-017-1 R2. Each Transmission Operator and Balancing Authority shall perform the functions specified in its Reliability Coordinator’s outage coordination process. X Single MOD-001-1a R1. Each Transmission Operator shall select one of the methodologies1 listed below for calculating Available Transfer Capability (ATC) or Available Flowgate Capability (AFC) for each ATC Path per time period identified in R2 for those Facilities within its Transmission operating area: - The Area Interchange Methodology, as described in MOD-028 - The Rated System Path Methodology, as described in MOD-029 - The Flowgate Methodology, as described in MOD-030 X Single Responsibility Standard Req. Text of Requirement CAISO TE Responsibility (either Each, Split, Single or N/A) Responsibility Details MOD-001-1a R6. When calculating Total Transfer Capability (TTC) or Total Flowgate Capability (TFC) the Transmission Operator shall use assumptions no more limiting than those used in the planning of operations for the corresponding time period studied, providing such planning of operations has been performed for that time period. X Single MOD-008-1 R1. Each Transmission Operator shall prepare and keep current a TRM Implementation Document (TRMID) that includes, as a minimum, the following information: X Single
IRO. Responsibilities The IRO shall:
1. perform each Quarterly Claims Review in accordance with the specific requirements of the IA;
2. follow all applicable Medicare and state Medicaid program rules and reimbursement guidelines in making assessments in the Claims Review;
3. request clarification from the appropriate authority (e.g., Medicare contractor), if in doubt of the application of a particular Medicare program, policy, or regulation;
4. respond to all OIG inquires in a prompt, objective, and factual manner; and
5. prepare timely, clear, well-written reports that include all the information required by Appendix B to the IA.