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 by identifying potential errors or gaps.

With the largest, most extensive review network in the industry, multiple accreditations, UR licensing in all states that require it, and industry-leading turnaround times (TATs) on qualified reviews, MRIoA’s professionalism, enthusiasm and collaborative approach are transforming healthcare.

CLINICAL REVIEW SERVICES

CLINICAL PEER REVIEWS

  • Meet TAT and quality metrics and consistently ensure safe, efficient, member-centered care

SPECIAL INVESTIGATIONS UNIT (SIU)

  • Review cases for fraud, waste and abuse to ensure high quality care for members

DIAGNOSIS-RELATED GROUP (DRG) CLINICAL VALIDATION REVIEW

  • Get validation of assigned diagnoses, to confirm proper payment

DISABILITY REVIEWS

  • Submit your cases via our easy-to-use web-based platform to get fast, high quality reviews from our world-class reviewers.

UTILIZATION REVIEW SERVICES

INITIAL AND APPEAL REVIEWS

  • Nursing and Medical Director Reviews
    • Pre-service/Prior Authorization
    • Concurrent
    • Retrospective
  • Specialty-Matched Appeal Reviews
    • Reviews from same or similar specialty-matched physicians
  • Medicare Advantage Organization Determinations and Reconsiderations

SPECIALTY SOLUTIONS AVAILABLE IN

  • Behavioral Health
  • Genetics
  • Sleep
  • Orthopedics
  • Imaging
  • Pain Management

DENTAL REVIEWS

ALLIED REVIEWS

FEDERAL AND STATE EXTERNAL REVIEWS

  • Independent specialty-matched reviews
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| Your Trusted Partner for Clinical Guidance

Industry-Leading
Turnaround Times:

You Ask, We Deliver

Contact Us

600

PHYSICIAN AND ALLIED HEALTH REVIEWERS

150

SPECIALTIES

30

MDs/DOs ON STAFF

20

INTERNAL SPECIALISTS

25

NURSES ON STAFF

20

PHARMACISTS ON STAFF

Physician

Licensure

IN ALL
50 STATES

“MRIoA has always been my first choice for peer reviews, UCR assistance, and plan language interpretation regarding clinical. The reviews are easily understood, and the clinicians always answer all questions that are posed for review.”

- Supervisor at a Nationwide TPA

“I have always had a great experience with MRIoA. The staff members are the experts in their positions. Absolutely one of the best companies for communication and problem solving and correcting/clarifying outcomes. Always receive updates and the staff is wonderful to work with.”

- Case Manager at a Medical Management Organization

“Management is responsible for employee attitudes. Your employees have been nothing but professional, friendly, and always aim to respond to my questions in a timely manner. I appreciate that every bit as much as I appreciate the quality of the reviews. Kudos to management and kudos to staff.”

- Claims Specialist at an Insurance Provider

“Your staff is extremely easy to work with, gracious, follows up appropriately, and responds quickly. It's wonderful to work with your company in an age where customer service is dead/dying! I have always been a strong advocate of excellent CS, so it's great to see elsewhere! I'm very happy with the review process and format in which the review is provided.”

- Claims Manager at an Insurance Benefit Administration Company

“Positive attitude, turnaround time and completeness of reviews. I truly appreciate our relationship with your company. I have been very impressed with overall responsiveness and the ability to develop unique solutions for customers without a great deal of hassle for the customer.”

- Director of Medical Management at a Non-profit Health System
News
09/14/2021

Medical Review Institute of America (MRIoA) Sponsors Self-Insured Institute of America (SIIA) Annual Conference

September 14, 2021 Medical Review Institute of America (MRIoA) Medical Review Institute of America (MRIoA), a proud member of SIIA, is excited to sponsor the upcoming 41st SIIA Annual National…
News
09/14/2021

Medical Review Institute of America (MRIoA) Sponsors California Association of Health Plans (CAHP) Annual Conference

September 14, 2021 Medical Review Institute of America (MRIoA) Medical Review Institute of America (MRIoA) is excited to sponsor the 2021 CAHP Annual Conference. During the conference, MRIoA will be…
White Papers
09/10/2021

MYCARECHOICES™ Rx

Independent 2nd opinion of high-cost specialtydrugs to ensure evidence-based care andmanagement of the patient’s condition, published September 10, 2021