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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

Improving Quality of Care

Clinical and Utilization Review Solutions Lower Costs and Provide More Effective Treatment for Patients

Delivering Better Outcomes for Patients, Providers and Payers

MRIoA provides independent clinical and utilization reviews to help health plans, PBMs, TPAs and government entities increase member satisfaction, reduce healthcare costs, and ensure appropriate care.

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. With the largest, most extensive review network in the industry, multiple accreditations, UR licensing in all states, and industry-leading turnaround times (TATs), partnering with MRIoA ensures appropriate care and positive patient outcomes.

Our Clinical Review Services Include:

Clinical Peer Review
Quality of Care
Special Investigations (F/W/A)
Disability
Clinical Incident Management
Workers’ Compensation
Clinical Validations
Medical Policy Review
Coding and Fee Analysis
P&T Committee Support

Our Utilization Review Services Include:

Health and Pharmacy Review
Initial UM (Nurse, Pharmacist, Physician)
Appeals and Grievances (Same or Similar Specialty)
Peer-to-Peer
All Lines of Business (Commercial, Medicaid, Medicare, Exchange, FEP)
Standard and Expedited Review



Specialty Solutions

Behavioral Health
MSK (Musculoskeletal)
Genetics
Sleep
Medical Imaging
Pain Management

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.

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.

Meet with one of our experts to get started.

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