NAIRO Calls for Higher Quality Independent Peer Review By Ending Restrictive State Laws

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New position paper seeks to align state-based independent review with nationally recognized standards

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Specifically, NAIRO believes that restrictive state laws can increase conflicts of interest, restrict access to qualified peer reviewers, limit independent review options, and fail to align with national standards of excellence.

In support of high-quality independent peer review, NAIRO seeks to bring attention to restrictive state laws that may have unintended consequences through a new position paper on this important area of public health policy.

The position paper, Restrictive State Laws Can Compromise the Integrity of Independent Review, contends that state legislation that restricts the quality and access of independent peer review determinations can result in subpar outcomes for both consumers and health plans.

“Some states have implemented policies that limit their options regarding access to independent peer review of adverse determinations,” said Gib P. Smith, Executive Director, NAIRO. “While lawmakers may have good intentions when passing such legislation, it may result in unintended consequences, such as limited options for patients and health plans when these parties use independent peer review.”

Independent peer review plays a critical role in achieving transparent, evidence-based medical claims reviews. When functioning optimally, independent review helps to ensure a fair and impartial claims appeals process.

However, a total of 18 states mandate some form of restrictive requirements that payers and IROs must adhere to when conducting internal and external review. Through past correspondence to state commissioners and state governors, NAIRO has voiced its objections to restrictive same-state licensure laws.

Instead, NAIRO calls for all states with restrictive independent review laws to revisit their state legislation in the interest of ensuring quality-based independent peer reviews. Specifically, NAIRO believes that restrictive state laws can increase conflicts of interest, restrict access to qualified peer reviewers, limit independent review options, and fail to align with national standards of excellence.

To read the full Position Paper, go here: http://nairo.org/site/1920nair/NAIRO_Issue_Brief_Same_State_Licensure.pdf

About NAIRO

NAIRO (The National Association of Independent Review Organizations) was formed by the majority of URAC-accredited IROs. The mission of NAIRO is to promote the quality and integrity of the independent review process at the internal and external levels. Utilizing the expertise of board-certified clinicians throughout the country, NAIRO members embrace an evidence-based approach to independent medical peer review, in order to help resolve coverage disputes between enrollees and their health plans. More information can be found at http://www.nairo.org.

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Gib Smith
NAIRO
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