Evidence-Based Medical Reviews that Improve Patient Outcomes
Objective, Expert Medical Reviews, Gold Carding & Second Opinions
MRIoA brings significant value to providers through objective and expert medical reviews conducted by highly qualified and experienced healthcare professionals. These reviews ensure independent assessment of medical cases, unbiased evaluations, and support quality assurance and regulatory compliance.
By identifying potential gaps, we help providers enhance their practices. We also alleviate administrative burdens, allowing providers to focus clinical and strategic initiatives. Through peer-to-peer consultation, we foster collaboration and facilitate discussions on complex cases with experienced medical professionals who can assist in developing the right treatment plans.
MRIoA provides several key solutions beyond a standard medical review (i.e., Prior Authorization, Appeal or Federal External Review):
- Peer-to-Peer connection with our physician specialists ensures medical reviewers have the latest information to support their case, ultimately helping providers deliver the best care for their patients.
- Gold Carding services that enable providers to by-pass many prior authorizations processes with payers and drive speed of care for their patients.
- Virtual 2nd Opinion services to further reinforce the diagnosis and provide as many treatment options to patients as possible.
MRIoA focuses on the following services that deliver value to healthcare providers:
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 a 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.
PROVIDER GOLD CARD SERVICES™
Gold carding physicians involves granting certain providers the ability to bypass or streamline the prior authorization process based on their history of high-quality care and adherence to evidence-based guidelines. MRIoA’s solution eases the strain on internal staff, reduces cost and ensures the right care.
Harness the power of an independent review to ensure evidence-based care and appropriate utilization of treatments.