MEMBERS

NAIRO Symposium

As the leader in independent medical review, NAIRO and its member organizations, which comprise URAC-accredited groups, provide objective, unbiased medical determinations, using board-certified medical reviewers, to help clinical and claims management professionals appropriately allocate health care resources.

NAIRO performs its work collaboratively in committees and working groups. It holds quarterly member conference calls, and an annual Symposium to help inform current and prospective IRO members as well as healthcare organizations, media, analysts, and legislative and regulatory dignitaries.

Click here to review NAIRO's Code of Ethics Policy

COMMITTEES AND WORKING GROUPS

NAIRO has several committees that meet monthly, and from time to time initiates working groups to handle specific projects. NAIRO leadership comprises the Executive Committee, with the elected President as the Chair. The Executive Committee oversees nominations and approval for the various committee Chairs.

Accreditation Task Force

Chair: Seth Lewin, M.D.

Legislative/Regulatory Committee

Chair: Candace Daigle, CHC, CHA, OHCC, CHCO

Membership and Marketing Committee

Chair: Richard Lynch, ProPeer

Symposium Committee

Chair: Valerie Aiello, RN, MSHI

URAC Standards Committee Representative

Sarah O’Hara, National Medical Reviews


FULL MEMBERS

Alicare Medical Management      
         
    Claims Eval
         
EdiPhy Advisors   ESMSEF   FHAS
         
Focus Health Inc.  

HealthClaim Solutions

 

HHC Group

         
HQSI     IPRO
         
  Lumetra   MAXIMUS
         
MCN       New York County Health Services Review Organization
         
Medical Review Institute of America   MET Healthcare Solutions   NEXUS
         
    Physicians Review Organization   ProPeer Resources
         
      SFUR

 

ASSOCIATE MEMBERS

   MMRO

 

AFFILIATE MEMBERS

 

 

J.B. Medical Consulting Group

         

 

 

   

Thomas Hodgkiss, CFP
Healthcare Consultant

 

 


URAC ACCREDITATION FOR IROS

IROs that achieve URAC accreditation are committed to a fair and impartial medical peer review process that benefits both patients and physicians with grievances. The URAC accreditation is designed to assure that IROs are free from conflicts of interest, establish qualifications for physician performing independent medical peer review, address medical necessity and experimental treatment issues, have reasonable time periods for standard and expedited peer reviews, and appeals processes.

Accredited IROs pass a rigorous review occurring in multiple phases. The initial phase, which consists of completing the application forms and supplying supporting documentation, usually takes several months. The remaining three phases of the URAC accreditation process cover a period of approximately six months. These phases include the following:

  1. Desktop Review A thorough documentation review including audits of items such as formal policies and procedures, organizational charts, position descriptions, contracts, sample template letters, and program descriptions and plans for departments such as quality management and credentialing.
  2. Onsite Review – An onsite review to verify compliance with URAC standards. Management is interviewed about the organization’s programs and staff is observed performing its duties. Audits are conducted and personnel and credentialing files analyzed. Education and quality management programs are reviewed in detail.
  3. Committee Review – A review by two URAC committees that include professionals from a variety of areas in health care as well as industry experts selected from or chosen by URAC’s member organizations. The committee review process begins with a written summary documenting the findings of the desktop and onsite reviews. This summary is submitted to URAC’s Accreditation Committee for evaluation with discussion with the review team as needed. An accreditation recommendation is then forwarded to URAC’s Executive Committee, which has the authority to grant accreditation.

IROs that successfully meet all requirements are awarded a Full two-year accreditation, and an accreditation certificate is issued to each company site that participated in the accreditation review.

 

BECOME A MEMBER TODAY!