Skip to main content
Get the latest market insights and industry trends on Regulatory, Data, Pharmacy and Health   Webinar on Demand for MRIoA's spring Regulatory Roundtable Discussion   Webinar on Demand for MRIoA's High-Cost Specialty Drug Review Webinar

The MRIoA Clinical Solutions Platform

Utilization Review, Data-Driven Optimization Solutions and Proactive Second Opinion

Contact Us
1
Reviews each year
81
Delivered in under 4 hours
98
TAT
99
Quality

Your Utilization Review
And Analytics
Specialist

The MRIoA Clinical Solutions Platform™ is a comprehensive suite of data-driven solutions that enable the “right care, at the right time, in the right place” by streamlining clinical decisions, creating a clear path for prior authorization, and offering expert second opinions and utilization review services.

Experience valuable data insights, cost savings, and faster decision-making with our innovative technology and patient-centered approach: A ClearPath to Clinically Relevant Simplicity.

Clinical and Utilization Review

Our objective evidence-based clinical reviews including ClearPath Prior Authorization™, specialty appeals and many other types of reviews, help increase quality of care for members, reduce cost for payers, simplify processes for providers and manage overutilization. As part of our clinical and utilization review services, we monitor and ensure compliance with State and Federal regulatory requirements.

Clinical and Utilization Review

Data Driven Optimization Solutions

Leveraging MRIoA Insights™, our proprietary UM analytics and benchmarking database, we optimize the prior authorization process, create customized benchmarking and analytics, offer Gold Carding services for providers, and provide therapeutic alternatives for high-cost specialty drugs.  Our actionable insights enable the “right care, at the right time, in the right place” while providing an average of $10M per 100K members ROI over three years.

UM Benchmarking and Data Solutions

Proactive
Second Opinion

MyCareChoices™ is MRIoA’s proactive telehealth 2nd opinion solution that works in conjunction with your approved prior authorizations. The service enables members and patients to better understand their condition and treatment options. The solution is easy to implement – requiring no IT integration and saves $800K for every 100K members.

Second Opinions

MRIoA Adaptive Clinical Solutions Platform

A comprehensive platform with data-driven solutions that enables “the right care
at the right time, in the right place” A Clear Path to Clinically Relevant Simplicity
  • Client Tools
  • Reviewer Tools
  • API Direct Connect
  • Direct To Client
  • AI Case Processing Tool
  • Clinical Reviews
  • Plus Image
  • MRIoA Insights
  • ClearPath PriorAuth
  • PA Optimization
  • MyCareChoices
  • Specialty Drug Reviews
  • Gold Card Services

Client Tools

ClientTools™ include an integrated case submittal process and fully customizable submittal forms, workflows, robust reporting capabilities and access control.

Reviewer Tools

MRIoA uses a nationwide network of board-certified physicians and professionals in all specialties and subspecialties of medicine that are in active practice. Reviewer Tools™ provides a simple interface for our review panel to access patient records, submit reviews, collaborate, learn and engage in a simple phone app or web-based platform.

API Direct Connect

MRIoA’s API solution significantly improves operational efficiency while reducing the cost of data entry through the direct transfer of case information without human interaction.  Our API can connect directly to your own system or through an UM/CM workflow platform, resulting in realignment of operational resources to higher ROI activities.

Direct To Client Systems

MRIoA’s physicians, nurses and pharmacists work directly in  our clients’  case processing systems to review and process cases, seamlessly integrating workflow and enhancing collaboration as we apply clinical guidance to the full patient record and ensure appropriate care.

AI Case Processing Tool

Proprietary software leverages artificial intelligence to facilitate and enhance the processing of clinical cases for quality and independent clinical reviews.  Automating appropriate elements of case analysis, including data extraction, pattern recognition and decision support, improving the efficiency, consistency and quality of final  reviews. Following the use of this tool set, every case is re-reviewed by a clinician to ensure quality.

ClearPath PriorAuth

Experience streamlined, fully customizable prior authorization from end-to-end prior authorization solution with ClearPath Prior Auth™. Our integrated solution suite combines powerful data-driven tools to address: PA optimization, proactive second opinions, provider gold carding, and management of high-cost specialty drugs in a single workflow.

PA Optimization

MRIoA’s PA Optimization(™) combines ~40 years of clinical expertise in Prior Authorization and appeals analytics across ~900 customers and 6,500 procedures to help optimize your PA program, enabling appropriate care for your members.  Our review results efficiently identify areas of savings and improvement while reducing your total number of prior authorizations.

MyCareChoices

MyCareChoices™ is a proactive telehealth second opinion solution tied to approved prior authorizations that enables members to better understand their condition and treatment options, saving money, ensuring the right patient care, and avoiding unnecessary procedures.

Specialty Drug Reviews

High-Cost Specialty Drug Reviews allow health plans, TPAs and PBMs to leverage national experts  through peer-to-peer calls with prescribers to ensure medication is optimized for the patient.

Gold Card Services

Gold carding physicians involves granting certain providers the ability to bypass the prior authorization process based on their history of high-quality care and adherence to evidence-based guidelines. With the growth in state legislation mandating Gold Carding, MRIoA’s solution eases the strain on internal staff, reduces cost, ensures the right care and helps you stay compliant.

Our MRIoA ClearPath solution streamlines the prior authorization process by delivering targeted utilization management and patient transparency so you can operate efficiently, increase clinical value and save on administration costs.

The benefits of ClearPath include:

  • Streamlined workflow

  • Faster authorization turnaround time

  • Cost reduction

  • Improved patient access to care

  • Increased provider productivity

  • Reduced provider-payer communication

View MRIoA ClearPath PriorAuth

PA Optimization

MyCareChoices

Patient Education

High-cost Specialty Drug Review

Provider Gold Card Services

Proven Value

Easy Access to Reviews & Case Submittal Process
Comprehensive Clinical Utilization Review
Database of 220M Cases & 40+ Years of Reviews
Industry-Leading Expertise & Benchmarking

Clear Benefits

Fast Clinical Reviews Delivered 7 Days a Week
Regulatory Compliance in all 50 States
Streamlined Prior Authorization Process
True Partnership & Patient-Centric Philosophy

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

1000

Clinicial Specialists

230

Full Time MD, RN and Rx on staff

40

Years of Experience

43 Clients
83 Patients

NPS

The Patient, Provider and Payer Value Stream

Enabling the right care, at the right time, in the right place while reducing friction
for patients, providers and payers

Provide Peace of Mind With Second Opinions

For patients and their advocates, our MyCareChoices™ virtual second opinion solution empowers better healthcare choices through external clinical reviews that validate medical opinions, help avoid misdiagnosis and uncover appropriate conservative therapies.

How We Serve Patients

Reviews That Help You Improve Patient Outcomes

MRIoA’s expert medical reviews, conducted by highly qualified and experienced healthcare professionals, ensure independent assessment of medical cases, unbiased evaluations, and support quality assurance and regulatory compliance.

How We Serve Providers

Transforming the Member Experience

For health plans, MRIoA improves the member experience by providing trusted clinical guidance, second opinions and appropriate utilization analytics and benchmarking that reduce costs and improve the quality of care for patients.

How We Serve Health Plans

Pharmacy Reviews You Can Count On

MRIoA provides pharmacy utilization review services and utilization management analytics that optimize member outcomes, control clinical costs, and ensure members have access to the right medications at the right time.

How We Serve Pharmacy Benefit Managers

Utilization Management for TPAs

For TPA’s, MRIoA offers utilization review solutions so you can ensure appropriate care while reducing costs. Our Nurses and Medical Directors work with your internal resources to assist with overflow or support your UM program needs.

How We Serve Third Party Admins

Utilization Management for the Public Sector

MRIoA helps government entities improve member outcomes, meet their quality metrics goals, and ensure payment integrity by providing thorough, professional clinical and utilization review services and appropriate utilization analytics.

How We Serve The Government

Utilization Management for Employers

MRIoA empowers self-insured employers by providing trusted clinical guidance and second opinion solutions that help you decrease costs and increase member satisfaction by providing conservative treatment options.

How We Serve Self-Insured Employers

Workers’ Compensation

Workers’ Compensation clients can leverage our clinical expertise, data-driven insights, and collaborative approach to streamline their utilization review and clinical review programs.

How We Serve Worker's Comp

Taft Hartley

Taft Hartley Plans can leverage our extensive clinical expertise, collaborative approach, and data-driven insights to streamline your utilization review and clinical review programs.

How We Serve Taft Hartley Plans

Resources

WebinarsResources
04/02/2024

Download the Spring 2024 Regulatory Roundtable Discussion

Case StudiesResources
03/03/2024

How Spark Hire’s Talent Acquisition Suite is Transforming Recruitment for Medical Review Institute of America

Webinars
02/15/2024

Download the MRIoA’s High-Cost Specialty Drug Webinar

High-Cost Specialty DrugsCase Studies
02/09/2024

High-Cost Specialty Drug Review Patient Stories

Read some personal experiences from our High-Cost Specialty Drug Review program.

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

Experience The MRIoA Difference For Yourself

At MRIoA, the patient is our focus in all our endeavors. You can put your trust in MRIoA to help you deliver the “right care, at the right time, in the right place” by streamlining clinical decisions, creating a clear path for prior authorization and offering expert second opinions and utilization review services.

Our ClearPath to Clinically Relevant Simplicity delivers fast, accurate clinical reviews, enhances provider performance, streamlines Prior Authorizations and ensures compliance with regulatory requirements.

Contact us today and experience the MRIoA difference for yourself.

Talk With Sales

All fields are required

First Name
Last Name
Email
Phone
Company

How Can We Help You?
Limited to 250 characters