named programs · 3 · from sources
What they call their work
Advocacy on Reviewer Anonymity
Defends the anonymity of medical reviewers to protect their safety and ensure impartial decision-making in independent reviews
NAIRO Position on Artificial Intelligence
Provides policy guidance and best practices for integrating AI into utilization review while maintaining human clinical oversight
Regulatory Engagement Initiative
Monitors and responds to state and federal legislation affecting independent review, including AI regulation and duty-of-care mandates
activities · 4 groups
What they do
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Healthcare Policy Advocacy 1 activity
- Advocates for sound independent medical review policies and regulatory standardsEngages in advocacy by monitoring state and federal legislative and regulatory developments affecting medical review and managed care, providing monthly updates to members, and advocating before regulatory bodies. Supports the development of external review processes, appeals regulations, surprise billing dispute resolution (IDR), and HUM/WCUM regulations, and facilitates member input to agencies.
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Professional Association Capacity Building 1 activity
- Builds capacity and facilitates collaboration among independent review organization membersSupports professional exchange and organizational development through an online collaboration portal (Basecamp), a member referral program, and an industry directory listing all members in good standing. Also governs the association through elected executive officers and an Executive Committee.
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Professional Networking Events 1 activity
- Hosts annual and quarterly educational conferences and meetings for independent review stakeholdersOrganizes an annual conference featuring educational content, networking opportunities, and professional development for stakeholders in the independent medical review industry, including executives, medical directors, and compliance officers. Also conducts quarterly member conference calls and virtual webinars to inform members about industry developments.
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Medical Research & Education Dissemination 1 activity
- Produces and disseminates research and educational resources on independent medical reviewConducts and publishes research, including white papers and consumer-facing guides, on the independent medical review process and challenges facing payors. Also co-developed and disseminated educational materials such as webinar presentations on external appeals for health plans.
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financials · form 990 · fy2024
revenue
Total revenue$214K
Contributions & grants$212K99%
Program service revenue$00%
Investment income$1K1%
Other revenue$1K
expenses
Total expenses$180K
Program expenses—
Admin / overhead—
Fundraising—
Salaries & benefits$0
Grants paid out$0
Largest expense lineProfessional Fees
balance sheet
Total assets$165K
Cash$165K
Investments$0
Liabilities$0
Net assets$165K
Liquid reserves11.0 mo
5 years on record · 2020–2024 · YoY revenue +17.7%
leadership · form 990 part vii · fy2024
Who runs it
board members · 6
- CARLENE BEYAH — SECRETARY
- ED BOLTON — DIRECTOR
- ERIC HATFIELD — VICE PRESIDENT
- FRANCES SCOTT — PAST PRESIDENT
- SARAH O'HARA — TREASURER
- VALERIE AIELLO — PRESIDENT
relationships · 30
Who they work with
- Blue Mountain Law, PLLC Partner — Gold sponsor of the 2027 NAIRO Annual Conference.
- Commence.ai Partner — Delivers a sponsor presentation at the NAIRO conference.
- Dane Street Partner — Engages with NAIRO through conference participation, with its Chief Strategy Officer and Director of Legal, Compliance, and Regulatory Affairs providing testimonials about the value of the NAIRO Conference.
- ESMSEF Partner — Participates in the NAIRO Conference, with its Executive Vice President praising the quality of speakers and topics at the event.
- Healthcare Quality Strategies Partner — Engages with NAIRO through conference participation, with its CEO noting the value of conference content for professionals across multiple departments.
- Kids’ Chance of Alaska Partner — Christine Carrey, a NAIRO officer, previously served on the board, indicating organizational affiliation.
- Kids’ Chance of Washington Partner — Christine Carrey, a NAIRO officer, previously served on the board, indicating organizational affiliation.
- LexisNexis State Net Partner — Subscribes to State Net to provide members with legislative and regulatory updates.
- ManageWare Partner — Participates in the NAIRO Conference, with its Vice President of Business Development highlighting the opportunity to connect with key leaders from Independent Review Organizations.
- ManageWare Partner — Sponsors the Cocktail and Networking Reception at the NAIRO conference.
- Maximus Partner — Collaborates with NAIRO through participation in the NAIRO Conference, with its Vice President of Federal Health attending and endorsing the event.
- McCoy College of Business Administration, Texas State University Partner — NAIRO member Ed Bolton serves on the Dean’s Advisory Board, indicating a formal relationship.
- Member companies Network — Collaborates with member companies to organize and stage the annual conference.
- NAIC Partner — Worked with NAIC to develop the Uniform Health Carrier External Review Model Act.
- NCQA Partner — Partners with NCQA to support independent review best practices.
- NMR Partner — Co-presented a webinar on external appeals with NMR.
- Nexus Partner — Engages with NAIRO through conference participation, with its CEO and President emphasizing the conference's unique focus on the IRO and UM market.
- RediMinds Partner — Participates in the NAIRO Conference, with its CEO describing it as an exceptional opportunity to connect with key leaders from Independent Review Organizations.
- RediMinds, Inc. Partner — Collaborated with RediMinds, Inc. through its AI Committee to conduct expert discussions on AI capabilities and limitations in the independent review context.
- URAC Government — Collaborates with URAC on standards development, accreditation, and regulatory advocacy.
- URAC Government — URAC accreditation is a prerequisite for Full or Associate NAIRO membership.
- URAC Network — Member organizations of NAIRO are URAC-accredited, and NAIRO engages with URAC standards through representation on the URAC Health Standards Committee.
- URAC Partner — Collaborated with URAC on a webinar and advocated for its recognition as an accreditation body.
- URAC Partner — Collaborates with URAC leadership and holds an active seat on the URAC Standards Committee to influence accreditation standards.
- URAC Partner — Collaborates with URAC on accreditation standards and revisions.
- URAC Partner — Collaborates with URAC, which presents on IRO accreditation standards and federal healthcare oversight trends at the NAIRO conference.
- United States Department of Labor Government — Collaborates on independent review best practices and regulatory matters.
- Wayland Baptist University Partner — NAIRO member Ed Bolton is a member of the Dean’s Advisory Board, reflecting an institutional connection.
- Workers’ Compensation Research Institute (WCRI) Partner — NAIRO member Ed Bolton serves on WCRI's Texas Advisory Board, indicating a professional affiliation between the organizations.
- iMEDECS Partner — Sponsors the Welcome Reception at the NAIRO conference.
strategies · 3
How they approach the work
Named approaches extracted from this org’s sources. Where others share an approach, follow it to see the full set of orgs running it.
- Collaborative Standards Development and Systemic Advocacymethodology: systemic_advocacyBy convening accredited organizations and engaging in collective advocacy, the organization shapes accreditation standards and influences systemic policies, because unified stakeholder action strengthens the integrity and consistency of independent medical review across the healthcare system.
- Expansion of Independent Review into Emerging Domainsmethodology: expansion_of_review_scopeBy advocating for the application of independent review principles beyond traditional medical settings—into pharmacological and disability determinations—the organization improves fairness and oversight, because extending proven review methodologies to new domains reduces bias and enhances accountability in high-stakes decisions.
- Independent Medical Peer Review for Fair and Unbiased Evaluationmethodology: independent_medical_peer_reviewBy utilizing independent medical peer review with board-certified clinicians and evidence-based methodologies, the organization ensures fair, objective determinations in medical disputes and prevents unnecessary procedures, because clinical independence and expertise are critical to maintaining trust and accuracy in healthcare decision-making.