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Utilization Management, Regulatory Compliance and Comprehensive Clinical Review Solutions

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Improve Member Care While Reducing Costs

Medical Review Institute of America (MRIoA) is the market leader for technology-powered, expert-led independent utilization management analysis and clinical review solutions.

For health plans, PBMs, TPAs, government entities and self-insured employers, we elevate the member experience by providing trusted clinical guidance, virtual second opinions, prior authorizations, regulatory monitoring and appropriate utilization analytics that both save money and empower patients.

CLINICAL AND UTILIZATION REVIEW

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.

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REGULATORY MONITORING

MRIoA’s regulatory monitoring services proactively track state and federal laws and regulations, identifying and resolving issues to ensure compliance with all requirements. From a clinical standpoint, we share regulatory change updates with clients so they can proactively make staffing and procedural to remain compliant. A strong and continuous commitment to innovation and flexibility, both in our processes and our products, ensure that we stay ahead of legislative changes and new regulations.

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CLEARPATH PRIORAUTH OPTIMIZATION

Our prior authorization optimization services give you confidence to prior authorize what you need – and stop wasting time on what you don’t. ClearPath is the simple way to enable the right care, at the right time, in the right place while reducing friction for patients, providers and payers. By partnering with MRIoA, our clients reduce unnecessary care by $1.7M annually per 100K member on average.

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PROACTIVE SECOND OPINIONS

MyCareChoices™ is a digital, telehealth-enabled, healthcare platform that provides patients with fast, reliable second opinions and conservative therapy options from world-class medical specialists., protecting against misdiagnosis and suboptimal treatment plans. With MyCareChoices™, members better understand their diagnosis and treatment options, and payers average $800K per 100K members in savings by reducing unneeded procedures. Best of all, this solution is seamless to implement as part of your standard PA process and requires no IT integration.

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SPECIALTY DRUG REVIEWS

High-Cost Specialty Drug Reviews allow health plans, TPAs and PBMs to leverage specialists through peer-to-peer calls with prescribers to ensure medication is optimized for the patient.

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Resources

Webinars
02/15/2024

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.
BlogWebinars
02/08/2024

Register for Election Year Health Check – Washington Insider Webinar

​​​​March 6, 2024 10:00 am PT | 11:00 am MT | 12:00 pm CT | 1:00 pm ET
Webinars
01/07/2024

Register for MRIoA’s Exclusive Webinar on High-Cost Specialty Drug Review PLUS Customer Testimonial

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.

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