Reform Law Expands Access to Appeals Procedures
For Immediate Release
(Lake Success, NY – September 30, 2010)
IPRO has won accreditation as an Independent Review Organization (IRO) by the nationally recognized URAC organization. IROs conduct impartial, independent reviews of appeals of health plan decisions lodged by patients and their representatives or providers. IPRO currently conducts these reviews in 15 states and the District of Columbia.
“We are grateful for this honor,” notes IPRO Senior Director Terese Giorgio, RN. “This certification is from the universally recognized authority in this area.”
IPRO utilizes a panel of over 300 board-certified, clinical peer reviewers to conduct IRO reviews as well as a team of contract attorneys. Clinical experts are credentialed and subsequently re-credentialed every three years. Physicians must have current certification by a specialty board of the American Board of Medical Specialties.
The new health reform law will substantially expand the number of Americans with the right to an external review of a health plan decision. Federal officials estimate that extending appeals rights to newly insured individuals, to enrollees in self-insured (ERISA) plans, and to individuals with fee-for-service as well as managed care coverage will result in new protections for an estimated 41million Americans by next year.
Now celebrating its 20th anniversary, the Washington DC-based URAC originally was incorporated as the Utilization Review Accreditation Commission. The organization now operates 27 accreditation programs. Four federal agencies recognize URAC accreditation and 46 states and the District of Columbia reference URAC accreditation through statute, regulation and publication.
IPRO is a national organization providing a full spectrum of healthcare assessment and improvement services that foster more efficient use of resources and enhance healthcare quality to achieve better patient outcomes. For more than 25 years, IPRO has been highly regarded for the independence of its approach, the depth of its knowledge and experience and the integrity of its programs. IPRO holds contracts with federal, state and local government agencies, and private-sector clients, in more than 33 states, territories and the District of Columbia. A not-for-profit organization, IPRO is headquartered in Lake Success, NY.