As a utilization review agent licensed or certified in every state that requires it, MRIoA has in-depth knowledge of state UR regulations and what is required in order to maintain compliance with those regulations. One of the requirements that can be very burdensome and costly for our clients is the requirement for a medical director to oversee the organization’s utilization management (UM) and quality management (QM) programs. To make things even more difficult, some states require that medical director to be licensed in that particular state. MRIoA can help our clients meet these requirements.
Currently 27 states require utilization review or private review agents licensed or certified in that state to have a medical director oversee their UM program, and 14 of those 27 states require the medical director to be licensed in that state. MRIoA has multiple full-time medical directors licensed in all states with that requirement. In order to assist our clients that may not have a medical director on staff, or that may not have a medical director licensed in a particular state, MRIoA is introducing a new compliance oversight service to help you meet those needs. We have added this service as a result of client demand and are currently providing it for several clients in a variety of states.
This new service offers an annual compliance desktop review of your UM program policies and procedures, as well as a random clinical audit of reviews completed during the year. The client may designate any number of states in which MRIoA will assist them with meeting the medical director requirements. MRIoA will then perform the oversight audit against the applicable regulations in those designated states. MRIoA’s new compliance service will help ease the burden of having to meet state medical director requirements and help clients save money by not having to employ their own full-time medical director.
To learn more about this new service, please contact our Marketing department.
Aja Ogzewalla, Director of Regulatory Compliance
