Clinical and Utilization Review Solutions Lower Costs and Provide More Effective Treatment for Patients
Delivering Better Outcomes for Patients, Providers and Payers
MRIoA provides independent clinical and utilization reviews to help health plans, PBMs, TPAs and government entities increase member satisfaction, reduce healthcare costs, and ensure appropriate care.
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.
Our Clinical Review Services Include:
Clinical Peer Review
Quality of Care
Special Investigations (F/W/A)
Disability
Clinical Incident Management
Workers’ Compensation
Clinical Validations
Medical Policy Review
Coding and Fee Analysis
P&T Committee Support
Our Utilization Review Services Include:
Health and Pharmacy Review
Initial UM (Nurse, Pharmacist, Physician)
Appeals and Grievances (Same or Similar Specialty)
Peer-to-Peer
All Lines of Business (Commercial, Medicaid, Medicare, Exchange, FEP)
Standard and Expedited Review
Specialty Solutions
Behavioral Health
MSK (Musculoskeletal)
Genetics
Sleep
Medical Imaging
Pain Management
Resources
Drive Cost Savings and Elevate Patient Care
Experience valuable data insights, cost savings, and faster decision-making with our innovative technology and patient-centered approach.
A ClearPath to Clinically Relevant Simplicity.
Meet with one of our experts to get started.
