Independent Review Organization Accreditation

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To perform external reviews of adverse benefit determinations, IROs must be accredited by a nationally recognized private accrediting organization. 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 the organizations performing IRO services are committed to a fair and impartial medical peer review process that benefits both patients and physicians.

This accreditation is designed to assure that Independent Review Organizations are free from conflicts of interest, establish qualifications for physician 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.

The URAC-accredited Independent Review Organization:

  • Is up to date on all federal and state regulations, organizational processes, data security and internal operations
  • Works with appropriately licensed and credentialed peer reviewers who are current on the latest medical standards and technologies
  • Ensures consistency, efficiency and accuracy in internal and external review recommendations.
  • Is equipped to deliver three types of utilization review services: retrospective, concurrent, and prospective
  • Provides expertise in experimental and investigational reviews, and are current on the accepted standards of care
  • Has immediate access to physicians and allied healthcare practitioners who are at the vanguard of medical treatments and services
  • Features expansive review panels of hundreds to thousands of experts who can provide access to all recognized specialties and sub-specialties
  • Provides advanced, ongoing education and training to ensure the use of reviewers who are knowledgeable about the most current peer-reviewed literature and evidence-based medicine
  • Adheres to standards and guidelines intended to avoid issues of conflict of interest
  • And more.

Get our Standards-at-a-Glance for Comprehensive Independent Review Organization, External Independent Review Organization, and/or Internal Independent Review Organization.

Who May Apply

Independent Review Organizations within the United States may apply.

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