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Medical Reviewers are the Backbone of MRIoA’s Clinical Review Services

Learn More About the Specialists on Our Best-In-Class Medical Review Panel

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Healthcare’s Leading Medical Review Specialists

MRIoA partners with a nationwide network of board-certified physicians and professionals in clinical practice covering over 150 specialties and subspecialties of medicine to review prior authorizations, appeals and a variety of other healthcare and pharmacy claims to determine treatment appropriateness.

Our panel of reviewers render a professional, independent and unbiased opinion, citing medical literature and treatment guidelines. The goal of these reviews is always to deliver the “right care, at the right time, in the right place” for the patient.

Types of Reviews

Pharmacy & Health Initial Reviews
Assess the appropriateness and necessity of medications, treatments, and healthcare services.
Pharmacy Specialty Appeals
Assess medication-related appeals to determine the appropriateness of the requested medications and treatment plans, ensuring compliance with clinical guidelines, medical literature and/or policy criteria.
Health Specialty Appeals
Review appeals related to various healthcare services to assess the medical necessity and appropriateness of requested treatments and procedures, based on clinical guidelines, medical literature and/or policy criteria.
Second Opinion Reviews
Offer independent and objective evaluations of medical cases, providing alternative viewpoints on diagnoses, treatment plans, and options to empower patients and healthcare providers.
Quality of Care Reviews
Evaluate medical records regarding healthcare services provided to ensure they meet established quality standards, identify areas for improvement, and promote safe and patient-centered care delivery.
Disability Reviews
Conduct detailed assessments of medical records as they apply to plan definitions of disability to determine eligibility and levels of disability benefits, providing fair and accurate evaluations.
Clinical Validations
Ensure the accuracy of each diagnosis or procedure documented/billed based on the documentation within the health record, ensuring it is supported by clinical evidence in the medical record.
Coding and Fee Analysis
Ensure accuracy and compliance in medical billing codes and fees through comprehensive assessments, promoting transparency and fair reimbursement for healthcare services provided.
Clinical Peer Review
Comprehensive evaluations of medical cases, undertaken by seasoned medical professionals, to determine the medical necessity and appropriateness of healthcare services.
Special Investigations (F/W/A)
In-depth investigations focused on potential Fraud, Waste, or Abuse (F/W/A) in healthcare, ensuring transparency, legality and adherence to standards.
Peer-to-Peer
Collaborative discussions between treating physicians and expert medical peers to share insights, clarify clinical information and ensure optimal patient care.

Reviewer Testimonials

Specialty Matching Capability

MRIoA actively monitors the performance of all our medical reviewers and consistently recruits new experts to meet evolving market demands so that we can match a specialist to almost any required capability.

ACUPUNCTURE
ADDICTION MEDICINE
ALLERGY
ALLERGY PEDIATRIC
ANESTHESIA
ANESTHESIA/PAIN MANAGEMENT
AUDIOLOGY
BARIATRIC SURGERY
BCBA (BEHAVIORAL ANALYST)
CARDIOLOGY
CARDIOLOGY PEDIATRIC
CARDIOTHORACIC PEDIATRIC
CARDIOTHORACIC/CARDIOVASC SURG
CHIROPRACTIC
CRITICAL CARE MEDICINE
DENTISTRY
DENTISTRY PERIODONTICS
DERMATOLOGY
DERMATOLOGY MOHS
EMERGENCY MED
ENDOCRINOLOGY
ENDOCRINOLOGY PEDIATRIC
ENDODONTICS
FACIAL PLASTIC RECON SURGERY
FAMILY PRACTICE
GASTROENTEROLOGY
GASTROENTEROLOGY PEDIATRIC
GENERAL SURGERY

GENERAL SURGERY COLORECTAL
GENERAL SURGERY PEDIATRIC
GENETICS
GERIATRICS
HAND SURGERY ORTHOPEDIC
HAND SURGERY PLASTIC
HEMATOLOGY
HEPATOLOGY
INFECTIOUS DISEASE
INFECTIOUS DISEASE PEDIATRIC
INFERTILITY
INTERNAL MEDICINE
MATERNAL/FETAL MEDICINE
MAXILLOFACIAL SURGERY
MEDICAL TOXICOLOGY
NEONATOLOGY
NEPHROLOGY
NEUROLOGY
NEUROLOGY PEDIATRIC
NEURO-ONCOLOGY
NEUROPSYCHOLOGY
NEUROSURGERY
NEUROSURGERY PEDIATRIC
OB/GYN
OB/GYN INFERTILITY
OB/GYN ONCOLOGY
OCCUPATIONAL MEDICINE
OCCUPATIONAL THERAPY
ONCOLOGY

ONCOLOGY PEDIATRIC
ONCOLOGY RADIATION
ONCOLOGY SURGERY
OPHTHALMOLOGY
ORAL SURGERY
ORTHODONTICS
ORTHOPEDIC BACK CODING
ORTHOPEDIC CODING
ORTHOPEDICS
ORTHOPEDICS BACK
ORTHOPEDICS FOOT
ORTHOPEDICS KNEE/SHOULDER
ORTHOPEDICS PEDIATRIC
OSTEOPATH
OTOLARYNGOLOGY
OTOLARYNGOLOGY HEAD-NECK SURG
OTOLARYNGOLOGY PEDIATRIC
PAIN MANAGEMENT
PATHOLOGY
PEDIATRIC CRITICAL CARE
PEDIATRIC INTENSIVE CARE
PEDIATRICS
PHARMACIST
PHYSICAL MED/REHAB
PHYSICAL MED/REHAB PEDIATRIC
PHYSICAL THERAPY
PLASTIC RECON SURGERY
PLASTIC SURGERY

PODIATRY
PREVENTIVE MEDICINE
PROSTHETICS
PSYCHIATRY
PSYCHIATRY /ADDICTION
PSYCHIATRY CHILD/ADOL
PSYCHOLOGY
PULMONOLOGY
PULMONOLOGY PEDIATRIC
RADIOLOGY
REPRODUCTIVE ENDOCRINOLOGY
RHEUMATOLOGY
SLEEP SPECIALISTS
SPEECH PATHOLOGY
SPORTS MEDICINE
THORACIC
TMJ
TRANSPLANT
TRANSPLANT / BLOOD,BONE MARROW
TRANSPLANT / HEART/LUNG
TRANSPLANT / KIDNEY
TRANSPLANT / LIVER
TRANSPLANT / PANCREAS
TRANSPLANT / PEDIATRIC
TRANSPLANT CARDIOLOGY
TRAUMA SURGERY
UROLOGY
VASCULAR SURGERY
…AND MORE…

Join the MRIoA Medical Reviewer Panel

Our reviewers are located nationwide and are clinical experts in their areas of specialization while they remain in active clinical practice. When cases are referred by MRIoA, they review prior authorizations or appeals for treatment to see if they meet nationally accepted medical and health plan guidelines. Reviewers provide their expertise as an unbiased, external source, and in compliance with ERISA/DOL and/or state laws.

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Diverse Experience and Continuing Education

Exposure to a wide variety of cases that consist of a board range of clinical scenarios, different than one might encounter in their day-to-day practice.

Contribute to Quality Care

Contribute to ensure that patients receive appropriate and medically necessary care to prevent overutilization or underutilization of services and promote evidence-based medicine.

Impact on Policy and Procedure

Have a direct impact on insurance polices and healthcare guidelines that can help shape broader healthcare landscape.

Personal Growth and Development

Gain perspective and understanding of the administrative side of healthcare while building upon critical thinking abilities.

What is a Reviewer?
Credentialing Process

Reviewer Credentialing & Onboarding

MRIoA’s Reviewer Credentialing is part of the standard process of evaluating and verifying the qualifications and credentials of physician reviewers. It is a crucial step in ensuring that the physician reviewers we work with have the necessary expertise and knowledge to accurately and effectively assess medical cases, claims and/or documentation.

Your credentialing process starts with our Credentialing Coordinator sending you an electronic application. Once our team receives your application, it will be processed and once complete, will be reviewed by our Credentialing Committee for approval. Once approved, your credentialing is complete, and you will move forward to receive the necessary training and complete a test case within your specialty. Upon completion of the training, you will be presented to the company as our newest physician reviewer.

Reviewer Credentialing

Once your application is received by the credentialing team, it will be assigned to a Credentialing Coordinator. The Credentialing Coordinator will email to let you know that your application has been received and will perform the necessary checks (NPDB, board certifications, state licenses, etc.). If additional information is needed, the Credentialing Coordinator will reach out to you via email so please be on the lookout for these emails to ensure your application is processed in a timely manner. Please be sure to check your SPAM folder as emails are sometimes filtered there incorrectly.

Once your application has been compiled and all the necessary checks/verifications have been performed, the Credentialing Coordinator will email you to let you know if your application has been approved or denied. We aim to have a decision on your application within 7 – 10 days of your application being received and assigned to a Credentialing Coordinator.

If approved, you will receive your MRIoA Agreement with COde of Conduct via Adobe Sign and an email containing the You’ve Been Credentialed PowerPoint with useful information to complete your test case. (Please note: It can take 24 hours to receive your agreement once you receive the approval email.). In order to continue with the credentialing process, you will need to confirm that you received these materials, sign your Agreement, and schedule your training session (30-45 minutes in duration; conducted via Zoom).

Once you have signed your Agreement and selected a training time, the Director of Provider Relations will conduct a 30-45-minute training session via Zoom in which she will go over accessing your cases in ReviewerTools and how to complete a case. After she has finished the training session, you will be given time to ask any questions you may have. She will also send a follow-up email with the information she went over so that you can reference it while completing your test case.

After completing your training, you will need to notify the Credentialing Coordinator when you are ready to receive your test case. The Credentialing Coordinator will then create a ReviewerTools profile for you and within 24 hours, you will receive an email with your ReviewerTools details to log in and complete your test case. This test case will have a 3-business day turn-around time, so if you have any questions or concerns, please reach out to the Credentialing Coordinator ASAP. Upon posting your test case, it will be reviewed by a medical director within 3 business days. If the medical director has questions or concerns that need to be addressed, you will receive an email and a text advising that you have a clarification request. You will have 1 business day to review the clarification request and submit your response. If the medical director has no further questions or concerns, you will receive feedback for your test case. Please be on the lookout for correspondence from your credentialing coordinator to prevent delays.

Once you have received and reviewed your test case feedback, please select a time slot that works best for you to complete your final onboarding meeting with the Director of Provider Relations. This final meeting will be conducted via Zoom and typically last 15 minutes. During this meeting, the Director of Provider Relations will go over your test case feedback and answer any final questions you may have. After this final meeting, you’ll receive a follow-up email with contact information for your assignment and completion teams.

Within 24 hours of completing your final onboarding meeting, the Credentialing Coordinator will send you an email with details for the ReviewerTools mobile app and will have announced you as a new member of our Reviewer Panel. If you do not receive your first live case within 1 week of being announced, please reach out to pr@mrioa.com so they can follow up with the assignment teams.

Drive Cost Savings and Elevate Patient Care

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

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Physician Reviewer Recruiter