Group Health External Peer Reviews

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Group Health Review Services

During MRIoA's 30+ year history we have worked hard to stay ahead of the ever changing landscape of healthcare. Whether it be evolving state regulatory requirements or broad federal programs such as the ACA we continue to provide our clients the products and services necessary as they meet existing and future claims challenges. Our reviews are thoroughly researched, summarized and supported to help claims personnel reach sound medical necessity decisions. Our services assist healthcare organizations, self-administered corporations, TPA's, disability carriers and Taft-Harley funds across the nation.

MRIoA is dedicated to providing the highest level of quality and customer service to our group health clients. As a result, in 2010 MRIoA decided to assign each of our clients to a specific, dedicated team of analysts. Teams consist of three or four analysts in our Case Assignment and Fulfillment departments that manage cases for a small number of clients. This system ensures that each case is handled by an analyst who is fully aware of every client specific need. Feedback regarding the team system has been very positive. Our clients love that they can call an analyst, who knows them by name, and discuss any question they have about their case.

Our services include:

Review Case Types:

  • Medical Necessity & Appropriateness of Treatment
  • Second Opinion
  • Experimental/Investigational
  • Coding/U+C
  • Cosmetic
  • Coverage Decision/Non Clinical
  • Rescission
  • Quality of Care

Categories:

Levels:

  • Initial (PA, Nurse or Medical Director options available)
  • Initial (Appeal)
  • Reconsideration
  • First Appeal
  • Second Appeal
  • State IRO
  • Federal IRO

Please contact MRIoA marketing for more information about the services we provide at:
800-654-2422, Ext. 6453.

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"I have been in the claims business for 43 years and have used MRIoA for the past 20 years with 4 or 5 different companies. I've always had good results that were objective and defensible. Thank you for your support and service."