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Why would a healthcare insurance payer want to use an IRO?

April 26, 2017Healthcare Insurance iro payer

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Why would a healthcare insurance payer want to use an IRO?

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An IRO can help a payer to comply with state insurance regulations, the federal Employee Retirement Income Security Act (ERISA) and U.S. Department of Labor regulations, and mandated deadlines. Many payers outsource their medical reviews to IROs because they cannot efficiently and cost-effectively manage the extensive infrastructure needed in-house. Also, many payers are for-profit organizations and don’t want to be perceived as denying treatment to cut costs. Turning to an IRO to review special cases can provide them with information to make better decisions.