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.
MRIoA focuses on the following services for health plans:
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.
- Initial Reviews
- 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.)
PROACTIVE SECOND OPINIONS
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.
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.
Harness the power of an independent review to ensure evidence-based care and appropriate utilization of treatments.