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NAIRO Symposium

 COMMITTEES  |  MEMBERS  |  URAC ACCREDITATION

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 Conference 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: Frances Scott, ESMSEF

The Accreditation Task Force gathers and shares information related to URAC standards to support NAIRO members in achieving and maintaining accreditation. The task force provides members with timely insights and resources that promote successful accreditation and ongoing re-accreditation effortss

Legislative/Regulatory Committee

Chair: Debora Santiago, IPRO

The Legislative/Regulatory Committee monitors and reports on developments in legislation, regulations, and case law affecting independent medical review and utilization review, using LexisNexis and State Net. The committee also analyzes these developments and recommends strategies to advance NAIRO’s mission and goals with legislators, regulators, and trade associations.

Membership and Marketing Committee

Chair: Stacie Wydra, HQSI

The Membership and Marketing Committee promotes NAIRO’s mission and goals through communication channels such as the website, press releases, feature articles, and position papers. The committee also supports membership growth by recruiting organizations that share NAIRO’s commitment to preserving the integrity and validity of the independent medical and utilization review process.

Conference Committee

Chair: Karen Cinibulk

The Conference Committee organizes and supports NAIRO’s annual conference. The committee identifies appropriate locations and venues, develops relevant program topics, secures subject matter expert speakers, and seeks sponsorship support to help offset costs and deliver a high-quality event.

URAC Standards Committee Representative

Chair: Sarah O’Hara, National Medical Reviews

The URAC Standards Committee Representative participates in quarterly and ad hoc URAC Health Standards Committee meetings and serves as an independent advisor to URAC. This role supports the development of quality standards and measures for use in URAC healthcare accreditation and certification programs.

Artificial Intelligence / Cybersecurity / Technology (ACT) Committee

Chair: Allison Xiong, IPRO

The Artificial Intelligence / Cybersecurity / Technology Committee advances the responsible, secure, and effective adoption of artificial intelligence and emerging technologies across the independent review industry. The committee supports awareness, collaboration, and practical guidance on technology-related issues affecting NAIRO members.

Certified IDRE Collaboration (CIC) Committee

Co-Chairs: Trish Prather and Joan Ragsdale, EdiPhy Advisors

The Certified IDRE Collaboration Committee supports the integrity, quality, and operational excellence of independent, impartial review performed by NAIRO member organizations certified as Independent Dispute Resolution Entities under the No Surprises Act. The committee serves as NAIRO’s voice on federal IDR policy and practice by monitoring regulatory developments, engaging with policymakers and regulators, sharing best practices, and promoting clear, consistent standards for IDRE certification, compliance, and dispute adjudication.

Bylaws Committee

Chair: Frances Scott, ESMSEF

The Bylaws Committee maintains, interprets, and recommends updates to NAIRO’s governing rules. The committee supports compliant, consistent, and effective organizational operations by helping define member rights, officer responsibilities, and meeting procedures.

Policies and Procedures Committee

Chair: Frances Scott, ESMSEF

The Policies and Procedures Committee supports a consistent and effective process for developing, maintaining, implementing, and monitoring the policies and procedures that govern NAIRO’s core business processes.

Strategic Planning Committee

Chair: Frances Scott, ESMSEF

The Strategic Planning Committee helps define NAIRO’s direction, priorities, and actions to support long-term success. The committee assists the NAIRO Executive Committee and Committee Chairs in setting goals, allocating resources effectively, and measuring progress toward alignment with NAIRO’s mission and vision.

FULL MEMBERS

     
         
       
         
  EdiPhy Advisors     
         
FHAS   Focus Health Inc.  
HHC Group
         
HQSI  

 

 
         
  IPRO  
         
 
MAXIMUS 		   Medical Review Institute of America
         
      MET Healthcare Solutions
         
   NEXUS   Physicians Review Organization
   

 

    
ProPeer Resources      

SFUR
         
     

  

AFFILIATE MEMBERS

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OneIRO Services

  


 


Praful U Bhatt, M.D.

 

        

 		        
         
         


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.

 

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