Immunization Exemption Reviews

Simplified exemption processing of COVID-19 vaccinations

Independent immunization reviews for states, employers, and schools provide a rapidly scalable, conflict-free solution for processing the surge of new exemption requests and/or appeals of denied exemptions.

The resources and experience to deliver

21 years

as a fully accredited independent review organization by the Utilization Review Accreditation Committee (URAC)


physicians and other specialized reviewers comprise our fully credentialed national panel representing all major licensed practitioner categories


state regulatory agencies served, along with the Centers for Medicare and Medicaid Services (CMS), the Department of Veterans Affairs (VA), the U.S. Office of Personnel Management (OPM)

Meeting comprehensive independent review needs to comply with OSHA ETS requirements

With the issuance of emergency temporary standards by the Occupational Safety Health Administration (OSHA ETS) that provide mandates aimed to reduce the transmission of COVID-19 at large workplaces in the U.S., requests for vaccine exemptions based on medical, religious, and other personal beliefs are expected to increase dramatically. Independent reviews provide a rapidly scalable, conflict-free solution that will be needed to process the surge of new exemption requests and/or appeals of denied exemptions.

Our Independent Immunization Exemption Review (IIER) solution

Maximus provides IIERs that assist state and federal government, schools, and employers achieve compliance with federal requirements to implement immunization mandates. We bring a powerful combination of established business process workflows and a supporting information technology platform to assist organizations in processing vaccine exemptions promptly and fairly. This combination also provides a turnkey, scalable solution flexible enough to accommodate program customization.

Contact us to learn more about the IIER solution

A turnkey solution for comprehensive exemption review and appeal services

  • Comprehensive review of exemption request documentation
    • Expert medical review of exemptions based on state and federal requirements
    • Administrative review of non-medical exemptions (e.g., religious, personal belief, etc. based on allowable exemptions)
  • Decision appeal review for medical and non-medical exemptions

    Leveraging our extensive experience in preparing medical appeals reviews, we thoroughly and meticulously collect and organize all documents and guidelines needed to conduct an accurate review of exemption decisions.

  • Customizable online portal
    • Exemption requirement information for:
      •  Individuals
      •  Health care providers
      •  Schools and employers
    • Online exemption registration and application
      • Secure online registration for individuals and providers
      • Ability to request documentation from providers
      • Secure document upload (including fax)
    • Full-service help desk support for applications and appeals
    • Appeal requests for existing exemption decisions
    • Ability to check status of exemption reviews online
    • Chat with a virtual assistant

Benefit from proven immunization review expertise

Our IIER team provides expert opinions, objective recommendations, timeliness, value, and efficiency. IIER also adds a layer of patient and public health protection to immunization exemption decisions. Our business model features document digitization, case management systems, and operations support. The composition of our diverse Maximus IIER team is based on large-scale business process management experience and public health subject matter expertise. For example, we tailor our clinical reviewers to match each exemption request to ensure that the right knowledge of a medical or other exemption issue is applied to both fairly and consistently process exemptions.

Contact us to learn more about the IIER solution

Helping California conduct independent immunization appeals reviews at schools

Under state law, the California Department of Public Health (CDPH) was required to monitor immunization rates at schools and institutions, including ensuring that immunization exemptions are valid. For those that were determined to be invalid, the State needed a trusted partner to perform an independent medical review (IMR) of appeals to these denied exemptions. With its long-standing support and successful operation of the State’s IMR process for the workers compensation program, CDPH turned to Maximus to manage this critical state program.

The largest provider of independent reviews of government-sponsored programs

Maximus is the established leader and the largest provider of independent reviews of government-sponsored benefit programs, including the Centers for Medicare and Medicaid Services (CMS), the Department of Veterans Affairs (VA), the U.S. Office of Personnel Management (OPM), as well as 44 state regulatory agencies. Having rendered millions of determinations of government-sponsored benefits across multiple state regulatory agencies as well as hundreds of thousands of eligibility appeals annually, our review programs provide surge support, create business process automation efficiency, and render medical opinions as needed.

The established leader in independent reviews

Learn more about our extensive experience providing independent reviews for government-sponsored benefit programs.

Our appeals and independent medical reviews work

We render fast, independent, accurate determinations through a combination of trained health professionals, optimized processes, and enhanced technologies that help streamline the most complex review programs, including eligibility, health, disability, and workers’ compensation.

Learn more about our process for objective medical reviews