OUR SERVICES

Medical Review Institute of America (MRIoA) delivers technology-enabled review services that increase member satisfaction, decrease the costs of overutilization, provide benchmarking analytics and empower members by offering them alternative choices through patient-focused virtual second opinion services.

Utilization Management Services

Clinical and
Utilization Review

  • Objective clinical reviews that leverage evidence-based medicine
  • Increase quality of care for members
  • Improve cost and manage overutilization
  • Monitor State and Federal regulatory requirements
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MRIoA Prior Authorization Optimization Platform™

  • MRIoA identifies and reviews 40 new procedures to prior authorize every 6 months while decreasing the number of low value PA categories
  • Reduce overall medical spend by $10M per 100K members over three years
  • Realize a 7:1 ROI
  • PA Optimization™ platform- based on MRIoA’s proprietary list of 5,500+ PAs designed to reduce inappropriate procedure utilization and costs
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MRIoA Regulatory Monitoring™

  • Understand the changing regulatory requirements
  • Identify states impacted + enhance capabilities to accommodate (i.e., specialty match, turn-around-times, same state licensure…)
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Telehealth 2nd Opinion / Health & Rx

MyCareChoices™
Telehealth 2nd Opinion

  • Empower patients with choices as part of PA
  • Provide evidence-based, reliable virtual second opinions from world-class specialists
  • Save up to $800,000 per 100,000 members (or a 3:1 ROI)
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 High-Cost Specialty
Drug Reviews

  • Independent review of high-cost specialty drugs ranging from $5K to $200K per month
  • Ensure evidence-based care and appropriate utilization of treatments
  • Actively manage drug spend
  • Peer-to-peer for therapeutic interchange with prescriber
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MRIoA Insights™ UM Benchmarking Analytics

  • Optimize the effectiveness of prior authorization (PA) process
  • Provide consultative analysis of PA/appeals overturn rates vs norms
  • Identify ongoing benchmarking for procedure costs vs norm and geography
  • Provide broad analytics to optimize your UM program
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WHO WE SERVE

PATIENTS

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HEALTH PLANS

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PHARMACY BENEFITS MANAGERS

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THIRD PARTY ADMINISTRATORS

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GOVERNMENT

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SELF-INSURED EMPLOYERS

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WHAT OUR CLIENTS SAY

“Turned around a continued stay review in a “New York minute”, for which the team and the VP & CMO is extremely grateful. MRIoA team goes the extra mile for the benefit of their members and it is greatly appreciated.”

Chief Medical OfficerMID-WEST BLUE CROSS BLUE SHIELD PLAN

“We want to thank MRIoA for stepping in and taking on volume and rather quickly while also providing the up most quality. It has really helped alleviate the strain on our MD’s.”

Chief Medical OfficerNATIONAL LEADING DIVERSIFIED HEALTHCARE BENEFITS COMPANY

“Thank you MRIoA for helping our company getting up and running while we are growing fast and needed a reliable partner like yourself. MRIoA is always there to assist with any needs we have and has been a great resource to our organization.”

Chief Medical OfficerNEWLY FOUNDED HEALTH PLAN

“I have always had a great experience with MRIoA. The staff members are the experts in their positions. Absolutely one of the best companies for communication and problem solving and correcting/clarifying outcomes. Always receive updates and the staff is wonderful to work with.”

- Case Manager at a Medical Management Organization

“Management is responsible for employee attitudes. Your employees have been nothing but professional, friendly, and always aim to respond to my questions in a timely manner. I appreciate that every bit as much as I appreciate the quality of the reviews. Kudos to management and kudos to staff.”

- Claims Specialist at an Insurance Provider

“Your staff is extremely easy to work with, gracious, follows up appropriately, and responds quickly. It's wonderful to work with your company in an age where customer service is dead/dying! I have always been a strong advocate of excellent CS, so it's great to see elsewhere! I'm very happy with the review process and format in which the review is provided.”

- Claims Manager at an Insurance Benefit Administration Company

“Positive attitude, turnaround time and completeness of reviews. I truly appreciate our relationship with your company. I have been very impressed with overall responsiveness and the ability to develop unique solutions for customers without a great deal of hassle for the customer.”

- Director of Medical Management at a Non-profit Health System

“MRIoA has always been my first choice for peer reviews, UCR assistance, and plan language interpretation regarding clinical. The reviews are easily understood, and the clinicians always answer all questions that are posed for review.”

- Supervisor at a Nationwide TPA

700

PHYSICIAN AND ALLIED HEALTH REVIEWERS

150

SPECIALTIES

35

MDs/DOs ON STAFF

20

INTERNAL SPECIALTIES

25

NURSES ON STAFF

45

PHARMACISTS ON STAFF

Physician

Licensure

IN ALL
50 STATES

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| Your Trusted Partner for Clinical Guidance

Industry-Leading
Turnaround Times:

You Ask, We Deliver

RESOURCES

As an industry leader in clinical review services based on evidence-based medicine, part of our mission is to provide our clients and the larger medical community with educational resources on technology, procedures, compliance and other healthcare topics. You can explore our webinars, articles and resources here.

09/28/2022 in News

Medical Review Institute of America (MRIoA) Sponsors SIIA 2022 National Conference

Medical Review Institute of America (MRIoA) is excited to be a proud member and sponsor of the SIIA 2022 National Summit. Stop by  MRIoA’s booth 415 to talk about the…
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09/20/2022 in Blog

Second Opinions Make A Difference With MRIoA’s MyCareChoices™- Your telehealth 2nd Opinion

By Payton Babb Sy, RN BSN Research shows that 20% of patients with serious health problems are initially misdiagnosed- which results in nonessential and expensive procedures. These unnecessary treatments cause…
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09/12/2022 in Blog

Changes in Nursing Licensure Exams: What Healthcare Businesses Need to Know

By Payton Babb Sy, RN BSN At a time when the necessity for nurses is at an all-time high, the National Council Licensure Examination (NCLEX) is being restructured. Understanding these changes…
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COMPLIANT IN ALL 50 STATES

The MRIoA Compliance Program proactively tracks applicable state and federal laws and regulations, and identifies and resolves issues to ensure compliance with all state and federal requirements.