The continuous evolution of the health care industry and standards of care are astounding. Health care organizations can reduce their liability, improve their customer service and efficiency, and ensure legal compliance through the use of an Independent Review Organization (IRO). Companies who utilize an IRO typically experience the following benefits:
- Reduced liability through the utilization of external, Board Certified Specialists in the same or similar field of service as the original provider(s).
- Reduced liability through the development of standardized medical criteria for prior authorization.
- Improved member satisfaction through provision of an unbiased, evidenced-based external determination.
- Ensured compliance with DOL/ERISA compliance guidelines.
- Ensured compliance with state and federal mandates for appeals and medical necessity denials.
The URAC standards assure that organizations that facilitate independent medical peer review are free from conflicts of interest, establish qualifications for clinical reviewers, address medical necessity and experimental treatment issues, have reasonable time periods for standard and expedited reviews, and appeals processes. An organization with a URAC accreditation strives for a fair and impartial medical peer review process that is of benefit to both patients and physicians.