HEALTHCARE
REVIEW
Our Network
Our multi-specialty physician reviewer network represents nationwide access from nearly all regions of the country and offers virtually every major specialty and subspecialty necessary to cover any medical review request.
Industry Involvement
MMRO has played an integral role in shaping our industry, and we understand the importance of continuing that leadership role. To this end, we maintain association memberships dedicated to safeguarding the integrity of independent review organizations and to promoting and protecting individual rights and benefits.
Staying on the Leading Edge
As a result of our industry knowledge, continuous improvement culture, and extensive physician reviewer expertise, we serve as the industry's leading healthcare resource on strategy, innovation, and leadership.
Independent Medical Review Services
Medical Necessity/Medical Appropriateness
Our physician reviewers will evaluate services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms to determine if it is reasonable, necessary, and/or appropriate based on evidence-based clinical standards of care.
Experimental/Investigational
Our physician specialists will determine whether a treatment or procedure is considered experimental or investigational by establishing whether reasonable and substantial scientific evaluation has been completed, effectiveness has been established, or the procedure or treatment has been accepted and generally used by the medical provider community.
Peer to Peer
If a “Peer to Peer” review is requested, our physician reviewer will contact the treating provider via phone to discuss the services under review as rendered by the treating physician.
Independent Medical Review Services
Preliminary Review
Evaluation of external appeal eligibility.
Utilization Review (Preauthorization/Prospective Reviews, Retrospective Reviews, Concurrent Reviews)
Evaluation of past, present, or future healthcare utilization and medical necessity on a case-by-case basis.
Appeal Review (Internal and Federal or State External Appeals)
Evaluation of a review decision that denies a benefit or payment at the non-binding internal or binding external level of review.
Independent Medical Review Services
.Quality of Care Review
Physician specialists address and/or prevent medical errors as well as unintended outcomes by assessing the quality of care that medical practitioners are providing.
No Surprise Act External Reviews
Evaluation of medical necessity, correct coding, and cost-sharing criteria based on the No Surprise Act legislation.
Clinical Guideline/Medical Policy Reviews
Specialty-matched evaluation of clinical guidelines or medical policy alignment with the most up-to-date, evidence-based standards.
