MRIoA provides clinical pharmacy utilization review services and utilization management analytics that support innovative healthcare treatment while optimizing member outcomes and controlling costs.

By partnering with us, pharmacy benefit managers (PBMs) can implement cost-saving solutions while increasing member satisfaction and ensuring members have access to the right medications at the right time.

MRIOA’S CLINICAL PHARMACY REVIEW SERVICES

Initial Prior Authorization Reviews

Fully outsourced solution, or support seasonal overflow work, including after hours, weekends, and holidays.
Reviewers: Pharmacy Techs, Pharmacists, Physicians

Appeals

Appeal determinations for clinical-based denials
Reviewers: Specialist Physicians, Non-Specialist Medical Directors and/or Pharmacists

Medicare Coverage Determination and Appeals (Reconsiderations and Redeterminations) Reviews

Get the clinical depth you need and ensure full compliance for Medicare
Reviewers: Non Specialty-Matched and Specialty-Matched Physicians

Medicare Compliant Pharmacy and Therapeutics (P&T) Committee

MRIoA can assist with full P&T committee support and help ensure Pharmacy Benefit Managers are CMS compliant
Reviewers: Pharmacists, Medical Directors and Specialty-Matched Physicians

MRIoA Insights™ UM Benchmarking Analytics

Deepen your view of prior authorizations (PAs) and appeals by comparing industry-level denial and overturn rates.

MRIoA’s Pharmacy Review
Services Include:

  • Commercial
  • Medicaid
  • Medicare Parts B and D
  • ACA Exchange

“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

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