Why Third Party Administrators (TPA's) use Independent Review Organizations (IROs)

In today's competitive health care environment, third party administrators (TPAs) turn to Independent Review Organizations (IROs) to assure fast and cost effective claims decision making on the most expensive and complex treatments for the patients they are administering benefits to. Third party administrators lack fundamental medical decision making that’s required to successfully administer health care benefits. Many TPAs have a part-time medical director. The director may be part time or come into the office for an hour or two a week to look at the most difficult treatments. But for TPAs administering patient populations of any size, it's difficult for a part-time medical director to keep up with the workflow necessary to adjudicate claims quickly and cost effectively.

In order to solve this problem, many third party administrators are turning to Independent Review Organizations (IROs). TPAs can easily send questionable cases requiring special medical knowledge to their IRO outsourcing partner for speedy decision making, knowing that each member getting fair, objective and unbiased attention. Third party administrators that use IROs get high speed decision making, lower costs for adjudicating complex claims and meeting regulatory compliance for any approval or denial of benefits. Many third party administrators use IROs not only to look at their most complex cases but also to provide fractional medical director services. AllMed has several clients who not only use us to do independent medical reviews but also use our medical director staff to attend regular utilization review meetings and claims adjudication meetings as a part of the TPA staff function. TPAs that use IROs this way greatly benefit from having a strong, integrated working relationship with the medical staff that only an IRO can provide cost effectively.