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
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Objective clinical reviews that leverage evidence-based medicine
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Increase quality of care for members
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Improve cost and manage overutilization
- Monitor State and Federal regulatory requirements


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 unnecessary care 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

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…)
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)

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
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
WHO WE SERVE
WHAT OUR CLIENTS SAY
700
150
35
20
40
60
Physician
Licensure
IN ALL
50 STATES

| 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.
Medical Review Institute of America (MRIoA) Sponsors AHIP 2023
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.