Ensure Appropriate Care While Reducing Unnecessary Costs
Utilization Management Solution for TPAs
MRIoA offers the clinical resources and insights Third Party Administrators (TPAs) 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 work in tandem with your internal resources to assist with overflow or support specific needs in your UM program.]
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.
MRIoA focuses on the following services for TPAs:
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)
MEDICAL DIRECTOR OVERSIGHT
MRIoA Medical Directors provide oversight for your claims review and utilization review processes.
ALLIED REVIEW SERVICES
Sleep, behavioral health, emergent care and musculoskeletal (MSK) services.
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.