Sally Newton

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.

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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.

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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.

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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.

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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.

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Gain access to our proprietary data warehouse covering 220 million lives and 40 years of medical review outcomes. MRIoA Insights™ provides utilization management analytics and industry benchmarking to drive clinical and business decisions. Deepen your view of prior authorizations and appeals by comparing industry-level denial and overturn rates and much more.

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Our holistic clinical and utilization reviews include: initial reviews, appeals, Federal and State external reviews, allied reviews, dental reviews, quality of care reviews, special investigations, DRG clinical validation and pharmacy reviews. Conducted by physician, pharmacist and nurse experts, our clinical reviews are delivered with world class speed, access, quality and simplicity.

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MRIoA’s 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.

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

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

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

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ClientTools™ is a secure, client customizable case submittal portal with integrated workflows and robust reporting and communication capability.

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Sally Newton, SPHR, SHRM-SCP