MRIoA Insights™ UM Benchmarking Analytics is the only utilization management data solution on the market to help you better manage your prior authorization (PA) process by comparing industry-level denial and overturn rates. Utilizing one million UM case benchmarking data sets across 150 specialties, we help health plans, PBMs, TPAs, government entities and self-insured employers improve the effectiveness of Prior Authorization programs.
Ensure your prior authorization denial rates are in line with industry standards
Identify cost impact of PA decisions
Monitor utilization trends
Go deeper to better understand rationale for denial overturns
Improve the effectiveness of Prior Authorization programs resulting in lower costs and promoting appropriate procedure utilization
Optimize PA coverage based on MRIOA broad program overview consultative process
Identify actionable improvements based on overturn rates, P2P connection rates, procedure costs against our proprietary benchmark database and industry cost data
IN ALL
50 STATES
TO SEE A LIST OF THE PRESTIGIOUS UNIVERSITIES WHERE OUR MEDICAL PROFESSIONALS HAVE STUDIED AND PRACTICED:
© 2023 MRIoA. All Rights Reserved.
Gold carding physicians involves granting certain providers the ability to bypass the prior authorization process based on their history of high-quality care and adherence to evidence-based guidelines. With the growth in state legislation mandating Gold Carding, MRIoA’s solution eases the strain on internal staff, reduces cost, ensures the right care and helps you stay compliant.
Learn More
High-Cost Specialty Drug Reviews allow health plans, TPAs and PBMs to leverage national experts through peer-to-peer calls with prescribers to ensure medication is optimized for the patient.
Learn More
MyCareChoices™ is a proactive telehealth second opinion solution tied to approved prior authorizations that enables members to better understand their condition and treatment options, saving money, ensuring the right patient care, and avoiding unnecessary procedures.
Learn More
MRIoA’s PA Optimization(™) combines ~40 years of clinical expertise in Prior Authorization and appeals analytics across ~900 customers and 6,500 procedures to help optimize your PA program, enabling appropriate care for your members. Our review results efficiently identify areas of savings and improvement while reducing your total number of prior authorizations.
Learn More
Experience streamlined, fully customizable prior authorization from end-to-end prior authorization solution with ClearPath Prior Auth™. Our integrated solution suite combines powerful data-driven tools to address: PA optimization, proactive second opinions, provider gold carding, and management of high-cost specialty drugs in a single workflow.
Learn More
Gain access to our proprietary data warehouse covering 220 million lives and 40 years of medical review outcomes. MRIoA Insights™ provides utilization management analytics and industry benchmarking to drive clinical and business decisions. Deepen your view of prior authorizations and appeals by comparing industry-level denial and overturn rates and much more.
Learn More
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.
Learn More
MRIoA’s proprietary software leverages artificial intelligence to facilitate and enhance the processing of clinical cases for quality and independent clinical reviews. Automating appropriate elements of case analysis, including data extraction, pattern recognition and decision support, improving the efficiency, consistency, and quality of final reviews. Following the use of this tool set, every case is re-reviewed by a clinician to ensure quality.
MRIoA’s physicians, nurses and pharmacists work directly in our clients’ case processing systems to securely review and process cases, seamlessly integrating workflow and enhancing collaboration as we apply clinical guidance to the full patient record and ensure appropriate care.
MRIoA’s API solution significantly improves operational efficiency and security while reducing the cost of data entry through the direct transfer of case information without human interaction. Our API can simply connect directly to your own system or through an UM/CM workflow platform, resulting in realignment of operational resources to higher ROI activities.
Reviewer Tools™ provides a simple, secure app and portal-based interface for our MD reviewer panel to access patient records, submit reviews, collaborate, learn, and engage in a simple phone app or web-based platform. MRIoA uses a nationwide network of board-certified physicians and professionals in all specialties and subspecialties of medicine that are in active practice.
Learn More
ClientTools™ is a secure, client customizable case submittal portal with integrated workflows and robust reporting and communication capability.
