URAC’s Independent Review Organization (IRO) accreditation standards validate that third-party organizations providing medical determinations are committed to a fair and impartial peer review process for both patients and physicians.
Advancing IRO Best Practices
URAC is proud to work with the National Association for Independent Review Organizations (NAIRO) to track related legislation and regulatory standards, advance accreditation standards and assess emerging trends in IRO practices. The NAIRO is comprised of more than 30 of most established and highly regarded IROs in the nation.
Benefits of Accreditation
URAC-accredited IROs undergo a thorough assessment process to standardize their clinical and operational approach. This accreditation assures that IROs establish reviewer qualifications, are free from organizational or reviewer conflicts of interest, address medical necessity and have reasonable timeframes for standard and expedited peer reviews and appeals processes.
Payers and consumers can be confident that internal and external appeals receive a comprehensive, accurate review and objective decision based on accepted standards of care. Additional benefits of URAC’s Independent Review Organization Accreditation include:
- Third-party validation that your high-quality program can help improve patient care while avoiding unnecessary procedures with no inherent benefit
- Enhanced credibility that your licensed and credentialed peer reviewers are current on the latest standards, peer-reviewed literature and evidence-based medicine as well as emerging technologies
- Risk management oversight and review protocols that protect patient rights, reduce client liabilities, enhance data security and ensure regulatory compliance
- A blueprint for ongoing operational efficiency, advanced reviewer education and training and program oversight
What to Expect
We will work with your team throughout the accreditation process as your organization demonstrates how you have a flexible framework for continuous assessment and improvement of IRO operations, regardless of review type (internal, external or both). While our experts define the standards of excellence for independent peer reviews, they do not prescribe how organizations must meet those standards.
URAC’s thorough approach stimulates innovation across the continuum of care through email, conference calls and educational webinars.
We award IRO accreditation for a full three years. View our standards-at-a-Glance here.
Who May Apply
Independent Review Organizations based in the United States may apply for IRO Accreditation.