MRIoA offers the clinical resources you need for all phases of your utilization review and clinical review programs, so you can ensure appropriate care while reducing unnecessary costs. Our Nurses and Medical Directors can work in tandem with your internal resources to assist with overflow or support specific needs in your UM program.

Our real-time utilization management benchmarking analytics help you deepen your understanding of the effectiveness of your process with analysis of prior authorizations (PAs), appeals, overturns and procedure cost.

SERVICES FOR THIRD PARTY ADMINISTRATORS

Clinical and Utilization Reviews

  • 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)

Allied Review Services

Sleep, behavioral health, emergent care, and musculoskeletal services

Medical Director Oversight

MRIoA Medical Directors provide oversight for your claims review and utilization review processes.

MRIoA Insights™ UM Benchmarking Analytics

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

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| Your Trusted Partner for Clinical Guidance

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