Independent Review Organization (IRO)
We are a URAC-accredited Independent Review Organization. We provide independent, objective reviews for denials involving medical necessity, experimental and investigational determinations. Our IRO services deliver fair, compliant determinations supported by rigorous clinical and regulatory analysis.
Accredited, Independent, Conflict-Free
URAC accreditation reflects a rigorous standard for independence, reviewer qualifications, and process integrity. Every EdiPhy review is conducted free of conflicts of interest, with reviewer assignments screened against the parties involved.
External Review for Appeals and Coverage Disputes
We perform external reviews across a range of matters, including denied claims, appeals, experimental and investigational treatment determinations, and coverage disputes. Findings are delivered within required turnaround times and formatted to meet state and federal requirements.
Specialty-Matched Board-Certified Reviewers
EdiPhy Advisors assigns reviewers based on the clinical specialty relevant to each case. Our reviewers are board-certified physicians who maintain active clinical knowledge and understand the regulatory context in which their determinations will be evaluated. Specialty matching ensures the review reflects genuine expertise in the care under question.
Regulatory Compliance Built Into the Process
Our IRO services are structured to meet state external review requirements, federal standards, and payer-specific protocols. We maintain documented processes for reviewer credentialing, conflict screening, turnaround tracking, and quality assurance.
Independence When the Determination Matters
Health plans, TPAs, state agencies, and healthcare organizations turn to EdiPhy Advisors when a determination needs to be genuinely independent and clearly documented. We approach every review the same way — objective clinical analysis, relevant specialty expertise, and findings you can trust.
