WASHINGTON, DC – June 6, 2018 – Demonstrating a commitment to ensuring that independent review organizations (IROS) have met rigorous standards in quality and accountability through accreditation, the state of Alaska has taken an important step in the protection of patient rights. As of May 23, to be eligible to conduct external reviews in Alaska, an IRO must be accredited by URAC. Accredited IROs can register in the state by filling out an application here.
Accredited IROs adhere to rigorous standards that promote a fair and transparent review process – which is vital to protecting patients’ rights. By law, consumers have the right to pursue an external review of denied claims performed by an IRO.
“The Affordable Care Act grants every patient the right to appeal a denial of services by their health plan to an independent review organization,” said URAC Vice President of Government Relations and Policy Aaron Turner-Phifer. He continued by stating “The primary objective of URAC accreditation is always to protect the consumer. URAC IRO accreditation validates an organization’s ability to conduct a knowledgeable, fair and unbiased assessment.””
According to the National Association of Independent Review Organizations (NAIRO), “recent legislations, such as the ACA, has gone to great length to solidify the important role of external review within the healthcare system… yet challenges remain, consumer confidence is low. Consumers can rely on accredited IROs to ensure consistency, efficiency and accuracy in internal and external review recommendations.”
“Accredited review organizations undergo a thorough screening process and standardize their entire operations to provide review for consumers and payer organizations,” NAIRO states in a white paper. “By using only accredited IRO organizations, health plans and consumers gain assurance that appeals receive a comprehensive review and objective decision.”
URAC’s Independent Review Organization Accreditation is designed to validate that IROs have a process to address conflicts of interest, establish qualifications for physicians performing independent medical peer review, address medical necessity and experimental treatment issues, have reasonable time periods for standard and expedited peer reviews, and appeals processes.
An IRO with URAC accreditation strives for a fair and impartial medical peer review process that is of benefit to both patients and physicians. Accredited IROs undergo a thorough screening process and standardize their entire operations to provide review for consumers and payer organizations. Health plans and consumers can be confident that appeals receive a comprehensive review and objective decision.
Founded in 1990, URAC is the independent leader in advancing healthcare quality through leadership, accreditation, measurement and innovation. URAC offers a wide range of quality benchmarking programs that reflect the latest changes in healthcare and provide a symbol of excellence for organizations to showcase their validated commitment to quality and accountability. URAC’s evidence-based measures and standards are developed through inclusive engagement with a broad range of stakeholders committed to improving the quality of healthcare. For more information, visit urac.org.
Che Parker, Vice President, Sales and Marketing
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