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Get the latest market insights and industry trends on Regulatory, Data, Pharmacy and Health   Download the latest Regulatory Round Table Discussion Impacting 13 states   Listen to the latest podcast on GLP-1 Drugs

Transforming the Member Experience

By Informing Care and Reducing Cost

Utilization Reviews for Health Plans

The MRIOA Clinical Solutions Platform™ is a comprehensive suite of data-driven solutions that enable the “right care, at the right time, in the right place” by streamlining clinical decisions, creating a clear path for prior authorization, and offering expert second opinions.

For health plans, MRIoA improves the member experience by providing trusted clinical guidance, second opinions and appropriate utilization analytics and benchmarking that reduce costs and improve the quality of care for patients.

Our reviews are thoroughly researched, summarized and supported, and our extensive experience in peer-to-peer review has allowed us to streamline processes, resulting in the fastest turnaround time (TAT) in the industry.

Experience valuable data insights, cost savings, and faster decision-making with our innovative technology and patient-centered approach.

A Clear Path to Clinically Relevant Simplicity.

Health Plans

MRIoA focuses on the following services for health plans:


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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  • Initial Reviews
  • Appeals
  • Federal and State External Review
  • Allied Reviews
  • Dental Reviews
  • Quality of Care Reviews
  • Special Investigations Unit (Fraud, Waste and Abuse)
  • Diagnosis-Related Group (DRG) Clinical Validation Review
  • Pharmacy Reviews (Commercial, Medicare Parts B and D)
  • Specialized Reviews (Disability, Prudent Layperson, Workers Comp, etc.)
Health Plans


MyCareChoices™ delivers a telehealth 2nd opinion from an MD specialist as part of the approved prior authorization process.  This enables the member to better understand their condition and treatment options, so they can make the best decision for themselves and their family. MyCareChoices™  delivers ~$800K per 100K members in savings by reducing unneeded procedures and requires no IT integration.

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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.

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Health Plans


Download the Fall 2023 Regulatory Round Table DiscussionWebinars

Download the Fall 2023 Regulatory Round Table Discussion

Please download the MRIoA Regulatory Round Table Discussion recording to learn about 13 different state regulations.
Trimming the Weight: Helping Healthcare Companies with the GLP-1 Drug Revolution PodcastPodcasts

Trimming the Weight: Helping Healthcare Companies with the GLP-1 Drug Revolution Podcast

Listen to our newest podcast and learn more about the GLP-1 drug revolution.
Provider Gold CardAt A Glance

Provider Gold Card

Learn how MRIoA can ease the burden of the new and existing Gold Card regulations.
Regulatory & Compliance Roundtable Discussion 2023Webinars

Regulatory & Compliance Roundtable Discussion 2023

Download our latest bi-annual Regulatory Roundtable discussion where we discussed the pending and proposed legislation and other regulations across multiple states.

Why Delay?

Harness the power of an independent review to ensure evidence-based care and appropriate utilization of treatments.

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