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

In a white paper titled “Understanding the Vital Role of Independent Medical Review and Utilization on 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, Q&As, and press releases, along with articles and presentations from industry influencers. These files are in PDF format.


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.


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.


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.


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.


NAIRO Expands Education, Engagement With 2015 Cross-Channel Communication Plan

NAIRO launches its presence on LinkedIn to reach more influencers in independent review.

Health Plans and IROs Can Work Together to Determine Proper Care for Eating Disorders

Reviews help make evidence-based coverage determinations involving eating disorders.

IROs Help Cut Health Plan Costs during the Recession

IROs can provide a broader range of specialists focused on medical niches than health plan providers or payers can afford to employ.

IROs Help Determine Medical Necessity of Growth Hormone Therapy

NAIRO describes its position on human growth hormone (HGH) and how to review medical necessity.


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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Stay informed on trends and developments shaping the independent medical review industry with blogs and news from NAIRO and industry influencers.