THIRD-PARTY ADMINISTRATORS

Utilization Management Services Built for TPAs

Configured utilization management that supports multi-employer benefit plans.

Empower Your Employer Clients to Manage Cost, Quality, & Care

Independent, policy-aligned clinical reviews configured to each employer’s plan design and built to scale and flex with your volume

Many third-party administrators (TPAs) are challenged to balance employers’ rising costs, members’ access to care, and the regulatory environment. You need a partner who can keep up.

MRIoA has spent decades helping TPAs navigate these challenges. We combine one of the industry’s most extensive reviewer networks with rigorous clinical standards and a proven track record of defensible outcomes – all delivered on timelines that don’t slow down your operations.

Built & Configured for TPAs

Evidence-based reviews conducted by expert clinicians, physicians, pharmacists, and specialists
UM capacity with predictable service levels without hiring permanent staff or straining internal teams
Multi-employer configurability, supporting each employer’s plan document, clinical criteria, and benefit structure

End-to-end utilization management services for TPAs seeking a fully-outsourced model
Compliant with URAC and NCQA accreditation standards and evolving state and federal requirements
Fully-delegated IRO services for state and federal external reviews when needed

Always the Right Expertise for Every Case

MRIoA configures clinical review services to meet the unique needs of TPA clients and members.

Self-Insured Employers

Our health and pharmacy reviews support self-insured commercial insurance customers, controlling costs, and improving outcomes.

Employers focused on ERISA compliance turn to MRIoA to demonstrate prudent oversight of healthcare spending, ensure benefits are administered consistently, and satisfy DOL fiduciary obligations while reducing audit risk and strengthening plan governance.

How TPAs Partner with MRIoA

We connect your cases to the right reviewers and the right specialties matched to your specific needs.

Health Reviews

Our team of clinicians, nurses, and physicians conducts a full spectrum of UM reviews — prospective, concurrent, and retroactive — including initial reviews, appeals, and state and federal reviews. As an accredited independent review organization (IRO), we perform special investigations to identify and address fraud, waste, and abuse.

Pharmacy Reviews

From prior authorization to formulary exceptions, we handle the full pharmacy review spectrum so your team can focus on strategy. We employ and contract with clinicians, pharmacy technicians, licensed pharmacists, and physicians to perform prospective, concurrent, and retroactive reviews, as well as peer-to-peer reviews. Our team leverages expertise for pharmacy and therapeutics committees.

Specialty Reviews

Our panel of 150+ specialists provide expertise to ensure members get appropriate care in specialties such as behavioral health, radiology, musculoskeletal, genetic testing, pain management, and sleep medicine.

High-Cost Specialty Drug Review

MRIoA connects prescribers directly with a specialist to review high-cost drug requests and explore clinically sound alternatives. The result is a more informed prescribing decision that controls drug spend while ensuring members receive appropriate, effective care.

Lower Medical Spend While Improving Quality of Care & Member Experience

With a panel of 700+ same-state licensed specialists across 150+ specialties, we bring the clinical depth and quality focus your TPA operations depend on.

Clinical Depth for Your Team

MRIoA conducts reviews with its in-house clinicians, physicians, and pharmacists and has built an extensive specialist panel with experience in utilization management.

Quality Decisions Without Delay

While meeting turnaround times, our team keeps treatment on track, eases administrative burdens, satisfies regulated processing timelines, and ensures peer-to-peer requirements are met without friction.

Evidence-Based Reviews

Independent clinical assessment means every prior authorization and every appeal is evaluated with evidence-based guidelines, free from conflicts that can compromise internal review.

Built Around TPA and Employer Needs

We configure our services to fit your operations and back them with the transparency, reporting, and clinical insights your team needs to stay informed and in control.

Reliable, Secure Infrastructure

Our HITRUST and SOC II compliant infrastructure protects your data at every touchpoint, ensuring it is securely managed, transfered, and analyzed.

Regulatory Compliance for TPAs

The MRIoA team stays ahead of state and federal requirements to understand how changes impact utilization management operations.

Perspectives for TPAs

Blog

03/25/2026

4 Best Practices to Get Better Outcomes and Better Member Experiences

Outsourcing utilization management (UM) used to be a “break glass in case of overflow” decision. Outsourcing served as a response to volume fluctuations, staffing shortages, or when an independent review…

Bre Legler

Blog

01/29/2026

From Policy to Practice: What Today’s Regulatory Shifts Mean for Clinical and Pharmacy Operations

Regulatory change is no longer episodic. It is cumulative, layered, and increasingly operational. Legislative and regulatory shifts are moving quickly from Capitol Hill and state capitols into day-to-day operations. For…

Katie Clark

Blog

09/29/2025

Is your Organization Ready for Fall 2025 State Regulatory Changes?

State legislatures and regulators are moving fast, and for payers, third-party administrators (TPAs), and pharmacy benefit managers (PBMs), the business impact is real. Starting this fall and continuing into early…

Katie Clark

Give Your Members Access to Better Care

Talk with our team about supporting your TPA operations.

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