URAC Independent Review Organization (IRO) Accreditation Consulting

What is URAC IRO accreditation?

URAC Independent Review Organization (IRO) accreditation is a validation that a third-party review entity conducts fair, impartial and clinically sound peer review determinations for patients and for the physicians who treat them. It looks at reviewer qualifications, conflict-of-interest controls, medical necessity processes and review timeframes. URAC governs the program and makes every accreditation decision. IHS, founded in 2002 by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC, guides organizations from readiness assessment through the award. IHS drafts the program documents for your reviewers and leadership to approve. Your organization's named contact submits to URAC.

Who needs URAC IRO accreditation?

An organization needs it when a state rule, a federal framework or a customer contract names URAC accreditation for independent review work. The organization types that pursue it include:

• External IROs that conduct adverse benefit determination reviews mandated by state insurance departments or the Affordable Care Act.
• Internal review organizations that conduct utilization review on behalf of health benefits plans.
• Comprehensive review organizations that perform both internal and external review.
• Workers' compensation peer review organizations that provide independent medical review.
• Independent Dispute Resolution (IDR) entities that resolve payment disputes under the No Surprises Act. See URAC IDR accreditation.
• Independent medical examination (IME) firms that are expanding into external review. See URAC IME accreditation.

What regulatory drivers apply?

IRO accreditation is not always voluntary. These frameworks shape the decision:

• The federal external review rule, 45 CFR 147.136(d), has a plan or issuer that is not covered by a qualifying state process assign an IRO accredited by URAC or a similar nationally recognized accrediting organization (regulation read October 4, 2026).
• Idaho's external review law presumes an IRO meets the state's qualification rules when a nationally recognized private accrediting entity accredits it under IRO standards the state's director has found equivalent or stronger (Idaho Code 41-5912, page opened October 4, 2026). Other states set their own IRO approval rules.
• Payer and customer contracts may name URAC accreditation as a qualification, so read each one.
• The No Surprises Act created an independent dispute resolution (IDR) entity category.

Rules differ by state, so check the rule in each state where you operate. IHS reads the contracts and state rules you give us and plans around what they name.

What do the URAC IRO accreditation standards cover?

The current IRO External Review standards are version 7.0. The table lists the main areas and what IHS reviews in each.

Standard area	What the work covers
Reviewer qualifications	Access to licensed physicians across the specialties and subspecialties of the reviews you conduct, with credentials verified and maintained.
Conflict-of-interest controls	Organizational and reviewer-level screening and disclosure protocols. IROs that perform both internal and external reviews disclose internal client relationships.
Review timeframes	Timeframes for standard and expedited reviews, and the operating capacity and data to meet them consistently.
Medical necessity criteria	Review processes grounded in evidence-based clinical criteria, applied consistently and transparently across determination types.
Appeals processes	Defined, documented handling of appeals and clear communication of determinations to all parties.
Quality management	An active quality management program that tracks performance metrics and shows improvement over time.

How does URAC IRO accreditation work, and how long does it take?

URAC's IRO accreditation runs in four phases. IHS sets the timeline for each IRO after discovery, because it depends on your readiness and on the document deadline URAC gives you after you sign its contract. Accreditation is awarded for a three-year period, and URAC can run a monitoring validation review during the term.

1. Phase 1, application. The organization completes URAC's short opening form, signs the contract URAC generates and pays the fee. URAC then sets a deadline for the document submission through AccreditNet.
2. Phase 2, desktop review. URAC reviewers examine submitted policies, procedures, reviewer credentialing files, conflict-of-interest protocols and operational documentation.
3. Phase 3, validation review. URAC's review team meets leadership and staff, audits personnel and credentialing files, reviews quality management programs and evaluates operational systems.
4. Phase 4, committee review. URAC's Accreditation Committee reviews the findings and URAC issues the accreditation determination.
5. Mid-cycle monitoring. A monitoring validation review, when URAC runs one, confirms continued compliance, including record-keeping and ongoing reviewer qualification requirements.

Where does IHS look for gaps in an IRO's accreditation readiness?

These are IHS's own review points. They are not URAC finding statistics.

• Specialty coverage gaps. Access to every needed physician specialty is not documented before submission.
• Conflict-of-interest documentation. Written screening is thin, particularly for dual internal and external review functions.
• Timeframe compliance evidence. The organization cannot produce data showing consistent adherence to expedited review deadlines.
• Policy-to-practice alignment. Policies are well written but followed unevenly.
• Mid-cycle readiness. The organization earns initial accreditation but is unprepared for a monitoring validation review.
• Standards version transitions. Re-accreditation comes under a newer standards version than the initial award.

What does URAC IRO accreditation cost?

The cost has three parts: URAC's fee, consulting fees and your internal staff time. URAC does not publish its fees. Each applicant gets its fee in its URAC contract and pays it at signing, so your named contact gets the figure from URAC.

IHS sets a fixed fee for each engagement after a free discovery session, because scope, number of sites and gap severity change the work.

How does IHS support IRO accreditation?

IHS brings an insider view of URAC's standards to IRO work. Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC, wrote URAC accreditation standards, managed its surveyor programs and adjudicated appeals. He knows URAC's standards and review processes from the inside. The IHS process covers standards acquisition, gap assessment, document and evidence mapping, mock review against the governing text and readiness support. IHS offers the following for first-time and re-accreditation IROs:

• Accreditation readiness assessment. A structured gap analysis against the current URAC IRO standards before you submit.
• Policy and procedure development. Drafting or revising policies to fit the standards, for your reviewers to approve.
• Reviewer qualification program design. Building or strengthening your physician panel documentation and credentialing processes.
• Conflict-of-interest program build. Designing screening, disclosure and documentation protocols.
• Desktop review preparation. Organizing your document submission so reviewers can follow it.
• Validation review coaching. Preparing leadership and staff, including mock interviews and process walkthroughs.
• Mid-cycle monitoring support. Ongoing monitoring of your program between reviews.
• Re-accreditation management. Support for organizations approaching their three-year renewal.

What this is not

• IHS is not an accrediting body and does not grant or influence a URAC decision.
• IHS drafts. Your organization's named contact handles every submission and all communication with URAC.
• This page is not legal advice about state or federal external review requirements.
• Preparation is not a guarantee of an accreditation outcome.

Frequently asked questions

What version of the URAC IRO standards does IHS work to?

The current IRO External Review standards are version 7.0, and IHS works to that version.

Is URAC IRO accreditation required?

It depends on your states, your payer and customer contracts and the type of review you perform. The federal external review rule and some state laws refer to accredited IROs. Check each state where you operate, and IHS will map the requirement to your program.

How long does URAC IRO accreditation take?

IHS sets the timeline after discovery, because it depends on your readiness and on the document deadline URAC gives you after you sign its contract. The four phases are the opening application, the desktop review, the validation review and the committee review.

What does mid-cycle monitoring involve?

It is a validation review that confirms you still meet the standards, including record-keeping and reviewer qualification requirements. IHS supports monitoring between reviews so your program stays ready.

What does IHS do for an IRO?

IHS runs a gap assessment against the standards, drafts policies and credentialing and conflict-of-interest programs, and prepares you for the desktop and validation reviews. Your reviewers and leadership approve every document.

How much does URAC IRO accreditation cost?

URAC does not publish its fees. Each applicant gets its fee in its URAC contract and pays it at signing. IHS sets a fixed fee for each engagement after a free discovery session.

Who is this not for?

It is not for an organization that wants IHS to apply to URAC or speak to URAC for it. Your named contact does that. It is also not for an IDR entity seeking its own designation, which has its own page on URAC IDR accreditation.

Related resources

• URAC IRO accreditation FAQ
• URAC IRO accreditation comparison
• URAC Case Management and Utilization Management
• Accreditation Consulting