| Which types of organizations use an IRO to provide | | | | use independent review organizations in order to |
| independent medical reviews or peer reviews? Many | | | | administer claims. Disability insurance carriers, their |
| companies can benefit from this type of | | | | TPAs and medical management firms also use IROs |
| service.Foremost are health plans and health insurance | | | | as well as workers compensation carriers, their TPAs |
| carriers that require an IRO in order to make sure that | | | | and medical management firms. Property and casualty |
| they adjudicate claims in a properly.Second are third | | | | firms that are paying out medical claims also turn to |
| party administrators (TPAs) that administer benefits | | | | independent review organizations to review claims. |
| and claims for health plan payers.Third are reinsurers | | | | Fraud units working inside larger health plans and |
| or stop-loss carriers. Stop-loss carriers use | | | | special investigative units use independent review |
| independent review organizations as a way to assure | | | | organizations to look at the medical necessity of |
| that they are getting a second objective and unbiased | | | | treatments and validate or to root out potential |
| opinion for their most expensive and complex medical | | | | provider fraud.As you can see, many different types |
| claims that they are called to provide coverage | | | | of organizations in different markets turn to IROs as a |
| for.Fourth are large self-insured corporations that pay | | | | critical source to decide, adjudicate and authorize |
| their own health care benefits. They are increasingly | | | | health care claims. IROs today are an accepted best |
| turning to IROs in order to help with their claims | | | | practice by the largest and the smallest organizations |
| decision making.Fifth are managed-care organizations | | | | that participate in managing care for patients |
| that are providing preauthorization point of care | | | | today.About AllMed Healthcare Management Founded |
| determinations for their patients.Sixth are utilization | | | | in 1995, AllMed is a URAC-accredited Independent |
| review companies. They use IROs to preauthorize | | | | Review Organization (IRO) serving insurance payers, |
| complex, special and costly treatments.Utilization | | | | providers, TPAs and claims managers nationwide. |
| management companies and business units inside | | | | Reviews are conducted by board-certified physicians |
| larger firms also use IROs. Medical management | | | | in active practice. AllMed's growing customer base for |
| companies use IROs routinely to outsource their claims | | | | its independent medical review and hospital peer |
| decision making and preauthorization of treatments. | | | | review services includes premier organizations, such |
| Union trusts also turn to Independent Review | | | | as Educator's Mutual Life, IMS Managed Care, Tenet |
| Organizations to make sure benefits are properly | | | | Healthcare Corporation, HealthGuard, several Blue |
| administrated for their union populations.All of these | | | | Cross Blue Shield organizations, TriWest Healthcare |
| organizations work in the health care space to provide | | | | Alliance, Allianz and many other leading healthcare |
| either payment services or preauthorization of | | | | payers. Read the AllMed Medical News Blog and the |
| treatments. There are other types of insurers that also | | | | Independent Review Organization Blog. |