New white paper defines the highest standards in vetting medical reviewers

ALBANY, NY – February 15, 2019 – Today the National Association of Independent Review Organizations (NAIRO) released a publication showcasing the key concept of clinician credentialing within the wider scope of independent medical review and utilization review.

The white paper, High-Caliber Credentialing: Protecting the Integrity of Medical Review, 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.

The purpose of clinician credentialing – a process that seeks to fully validate the expertise and acumen of reviewing clinicians prior to performing medical review determinations – remains central to fair and balanced decision-making. IROs and UR/UM entities utilize comprehensive credentialing and re-credentialing programs to ensure a fair and accurate review process.

“The act of credentialing is a core concept within the realm of medical review,” said Gib P. Smith, Executive Director of NAIRO, which is comprised of the majority of URAC-accredited IROs. “Increasingly, leading medical review companies and IROs are augmenting the standards for clinician credentialing to ensure clinical reviewers are fully qualified to render often difficult decisions.”

The white paper covers the leading checks-and-balances that IROs and UR/UM entities take to screen the identity and credentials of review candidates and secure experienced clinical reviewers who are not only highly regarded but also are appropriate fits for the various types of review decisions that occur.

“For patients and for health plans alike, secure credentialing is one of the most important aspects of the medical review process,” added Smith. The white paper details the ongoing efforts from NAIRO and its URAC-accredited member organizations to bolster clinician credentialing through continuous adherence to leading standards and innovative solutions. The publication offers an inside look at one of the key parts of independent medical review that often remains hidden from view.

About NAIRO

NAIRO (The National Association of Independent Review Organizations) was formed by the majority of URAC-accredited IROs. The mission of NAIRO is to promote the quality and integrity of the independent review process at the internal and external levels. Utilizing the expertise of board-certified clinicians throughout the country, NAIRO members embrace an evidence-based approach to independent medical peer review, in order to help resolve coverage disputes between enrollees and their health plans. More information can be found at www.nairo.org.