Independent review organization

An Independent Review Organization (IRO) is an entity that conducts independent external medical reviews of adverse health care treatment decisions.

IROs began by adjudicating and making decisions on medical claims in the government sector. Recently, they have increasingly been utilized by mainstream health plans and other types of entities that are making such determinations. Independent review organizations serve a dual role: they advocate for the patient while making sure that each patient only receives what they deserve based upon medical fact. They also focus on eliminating wasteful and unnecessary treatments.

Types of cases that an IROs might review include: Medical necessity determinations, standard of care, health plan language interpretations, hospital length of stay, experimental treatment reviews, investigational treatment reviews, physician credentialing reviews, hospital peer reviews, utilization reviews, disability reviews, workers comp reviews and property and casualty medical claims reviews.