Companies that Benefit from IRO Services

Any company working within the healthcare industry to provide either payment services or preauthorization of treatments will benefit from engaging the services of an independent review organization (IRO). Companies that typically use IROs for independent medical peer review include:

• Health plans and health insurance carriers Third party administrators (TPAs)
• Reinsurers or stop-loss carriers
• Large self-insured corporations that pay their own health care benefits
• Managed Care Organizations (MCOs)
• Utilization review and medical management firms
• Hospitals

Other types of insurers that use IRO services for independent medical reviews include:

• Disability insurance carriers
• Workers compensation carriers
• Property and casualty firms that are paying out medical claims
• Fraud units working inside larger health plans and special investigative units

Different types of organizations in a wide variety of markets are utilizing independent review organizations to decide, adjudicate and authorize health care claims. In addition to various types of insurers, hospitals and medical practices wanting to raise the quality of care and improve patient safety are systematically outsourcing medical peer review to IROs. These organizations know that they can get an objective non-conflicted decision and fast turnaround on quality of care issues. IROs have become an accepted best practice by organizations of every shape and size that participate in managing care for patients.