RESOURCES
HIGH-CALIBER CREDENTIALING: PROTECTING THE INTEGRITY OF MEDICAL REVIEW
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NAIRO identifies the rigorous standards that leading independent review organizations (IROs) and utilization review/utilization management (UR/UM) organizations adhere to when vetting clinicians for important decision-making activities related to appropriate health coverage.
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UNDERSTANDING THE ROLE
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In a white paper titled “Understanding the Vital Role of Independent Medical Review and Utilization Review Services,” NAIRO outlines the review process and seven challenges facing payors.
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MORE BACKGROUND ON INDEPENDENT REVIEW
These NAIRO resources include official white papers, position papers, letters, issue briefs, and Q&As, along with articles and presentations from industry influencers. These files are in PDF format.
ISSUES BRIEFS
Restrictive State Laws Can Compromise the Integrity of Independent Review
Some states have created requirements for independent reviews, restricting IROs and access to national experts.
Independent Review Expands Its Scope: Case Studies in Context
NAIRO makes the case for broader use of IROs in diverse settings such as pharmacological reviews and disability claims.
Providing Leading Assessments of Experimental and Investigational (E/I) Treatments
E/I treatments may be eligible for coverage, and evidence-based review can help in appeals.
A Consumer’s Guide to Navigating the External Review Options Under the New Health Insurance Marketplace
Information on external appeals in federal and state exchanges.
External Review Options Available Under the Federal Facilitated and State Marketplaces
NAIRO’s look at the external review processes as applied to federal and state exchanges.
Health Plans Embrace Outsourcing Key Business Operations to Independent Review Organizations (IROs)
NAIRO’s overview of the evolving role of IROs under the Patient Protection and Affordable Care Act.
POSITION PAPERS
Accredited, Compliant IROs Lead the Way to Fair and Transparent Medical Review
NAIRO steps in to clarify roles and responsibilities of IROs in internal and external review.
NAIRO Comments on Interim Final Rules – Section 2719 of PPACA
NAIRO’s comments on proposed conflict of interest (COI) language, submitted to HHS, DOL, and the IRS in Sept. 2010.
A Vision for Improving Healthcare in America
NAIRO weighs in on universal care, independent review, evidence-based decision making, and other issues.
WHITE PAPERS
How to Interpret the New Internal and External Appeals Regulations
NAIRO’s discussion of the appeal provisions in Section 2719 of the Patient Protection and Affordable Care Act.
Preserving the Integrity and Viability of Independent Medical Review
NAIRO’s look at some of the history behind the independent review movement.
ARTICLES
Getting the Most from an Independent Review Organization
Providing high-quality care while keeping healthcare costs under control requires collaboration, and often help from an IRO.
Independent Review Organizations for Peer Review
Can peer review help improve quality of care? Independent review is an important tool for doctors and risk managers.
OTHER RESOURCES
Mastering External Appeals: A Guide for Health Plans
Copy of the webinar presentation delivered by Bonnie Zickgraf of URAC and Elaine Nace of NMR on July 24, 2013.
Know Your Healthcare Appeal Rights
A free Q&A guide to help consumers understand how the denied claim appeal process works.
Group Requests Modification to the Affordable Health Choices Act
NAIRO signed a letter to Senator Edward Kennedy requesting addition of URAC as a recognized accreditation body.
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