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Independent Review Organization Accreditation Overview

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URAC’s newest version of Independent Review Organization updates our program in the following ways:

  • Reflects URAC’s updated Foundational Focus Areas
  • Aligns the streamlined standards with current industry best practice
  • Reduced document-upload requirements means less time to complete application

To perform external reviews of adverse benefit determinations, IROs must be accredited by a nationally recognized private accrediting organization such as URAC. View the interim final rules for group health plans and health insurance issuers under the ACA here.

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

Who May Apply

Independent Review Organizations based in the United States may apply for IRO Accreditation.