Nurse Review is a new product designed to provide reviews on prior authorization requests, appropriateness of emergency room admissions and other initial services as requested. The Nurse Review service, like the Initial MD review service, has been designed to assist with your prior authorization program.
MRIoA uses an independent RN panel to complete these reviews. The review report includes a summary of the case such as patient complaints, vital signs, pain, physical exam, labs, initial diagnosis, treatment given, final diagnosis and prescriptions given. A decision is made to approve or deny the services based on the information provided. If a Nurse is unable to approve the services in question, the case is forwarded to an internal Medical Director for a determination by a Medical Doctor.
MRIoA has the ability to complete a high volume of these reviews within preauthorization and initial review timeframes. The process is streamlined to minimize any interruption in the claims process.
If you are interested in using this service as a resource, please contact your Marketing Representative for details. The Marketing staff wishes us to convey that, like our Initial MD reviews, this product is Smart, Simple, Streamlined, and completed with Speed and Security resulting in Savings for you!
Valerie Ottman, CPC, CPC-H
Director of Quality Management