What type of review is an Independent Review Organization (IRO) responsible for providing?

An Independent Review Organization (IRO) is primarily responsible for conducting objective and unbiased audits of healthcare claims, practices, and services. This role is crucial in evaluating the appropriateness and necessity of medical treatment as well as ensuring compliance with relevant standards and protocols. The focus on impartiality is essential to maintain trust in the healthcare system, offering a neutral assessment that is crucial for proper utilization management and claims processing.

The function of an IRO revolves around providing independent evaluations that help payers, providers, and patients make informed decisions based on factual data rather than subjective influences. This capability is particularly important in resolving disputes regarding the necessity of care or claims denials, which supports both accountability and quality assurance in healthcare delivery.