Physician Peer Reviews Worker's Comp
MRIoA's case review process summarizes and documents the appropriateness of requests for treatment.
As a URAC accredited independent review organization our determinations provide nurses and case analysts evidence-based determinations that are sound and defensible. We reach out to treating physicians during our review processes to assure thorough and objective decisions that take into consideration the individuality of each case. We are focused on making sure our clients provide injured workers care that is appropriate, cost-effective and medically necessary. Our services include:
- Quality review decisions using nationally-accepted criteria and evidence-based guidelines
- Strong physician involvement in the review process
- Customized services
- Timely decisions
- National experience
Pre-Certification / Pre-Authorization Review
Our national panel of physicians provides effective reviews of proposed treatment, using evidence-based medical treatment guidelines in the process. MRIoA's experienced case analysts coordinate and review case referrals to make sure they meet client and state requirements. As requisite, peer-to-peer conversations are offered to the requesting physician whenever there is a potential for a denial of all or part of the requested services. This allows for open communication between the reviewer and the requester, assuring a complete review process.
Physician Peer Review
MRIoA offers a comprehensive peer review to assist in addressing broad areas of medical necessity and causal relatedness. These reviews are useful in identifying unproductive or unrelated treatment.
All reviews are sent to physicians in the same or similar specialty. Review physicians address specific questions posed in the referral, providing valuable information regarding the necessity and relatedness of the treatment. MRIoA utilizes evidence-based medical guidelines in the review process, with a list of citations included with each review determination. With our large national panel of physicians, MRIoA is positioned to address appeal reviews in the event a treating physician provides additional information or justification for the treatment.
MRIoA's contracted panel of review physicians includes over 133 medical specialties and sub-specialties represented. All review physicians are board-certified in their respective specialties. With a national panel, MRIoA affords our clients strong representation throughout the country. MRIoA adheres to state jurisdictional requirements that apply to services provided in various states, including issues of licensure and use of the appropriate review criteria and guidelines.
Want additional information? We're happy to provide sample review reports, sample quality reports, and answers to any questions you may have.
"The timeliness and thoroughness of the review is outstanding."