URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation and certification programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC strives to ensure that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry. For more information, visit www.urac.org.

IRO Services

MET Healthcare Solutions (MET), a URAC Accredited Independent Review Organization: Comprehensive, specializes in independent external and internal reviews for state insurance departments, group health insurance companies, worker’s compensation companies, utilization review companies, hospitals, employers, benefit administrators and casualty insurers on a national level. 

All reviews are performed by board certified (ABMS or AOA) physicians or certified healthcare providers who have undergone extensive credentialing to ensure the highest quality health care is delivered to the communities we serve.

REVIEW TYPES:

  • Medical necessity and Appropriateness
  • Level of care
  • Effectiveness of a covered benefit
  • Experimental/investigational
  • Cosmetic treatment or surgery
  • A rescission of coverage
  • Medical Imaging Review
  • Workers’ Compensation
  • Disability Review
  • Length of Stay
  • Dental Review
  • Mental Health
  • Pharmaceutical Review
  • Over-Utilization
  • Return to Work Potential
  • Duration of Impairment

 

REVIEW TURN AROUND TIMES:

MET offers clients reviews that are objective, defendable and derived from evidence-based medicine and clinical research in a quick, efficient manner.    Turnaround times are based on the type of review received and the client’s needs. 

STANDARD REVIEW

A standard review is an appeal that is not expedited and not related to cases involving urgent care/life threatening issues.  MET’s standard delivery time for review completion is 48 hours from receipt of all required documents and records.

EXPEDITED REVIEW

In the event of an Urgent care/life threatening case, MET’s standard delivery time for a decision is within 24hours of receipt of the information. 

OUR PROCESS:

MET creates a custom profile for each client/payer to assure their specific requirements, state and federal regulations and URAC standards are adhered to. 

Upon receipt of the case, a staff member at MET (trained in URAC, state and federal guidelines) will begin working on the case immediately.  The staff will select an appropriate reviewer determined to be a clinical peer (physician or other healthcare professional in the same or similar specialty) and an expert in their field of specialty. The case is assigned to the reviewer and accepted the same business day.  Completed determinations are returned to MET for quality assessment measures and then issued to all required recipients.