Medical Review Institute of America, LLC

Medical Review Institute of America, LLC (MRIoA) was incorporated in 1983. Today MRIoA is an industry leader in providing external review resources for over 800 clients nationwide. MRIoA provides review of medical, dental, behavioral health, pharmacy, vision, disability, workers'​ compensation, and auto claims for insurance carriers, employers, TPAs, self- administered union groups, pharmacy benefit managers, human resource consultants and departments of insurance throughout the country. MRIoA utilizes a nationwide network of board-certified physician specialists and professionals in over 133 specialties and sub-specialties of medicine. MRIoA also has reviewers in most states, offering the most extensive same-state reviewer resources available from an external review organization. MRIoA holds dual accreditation with URAC with certificates in Health Utilization Management and as an Independent Review Organization. In addition we are NCQA and SSAE 16 certified. MRIoA's goal is to render a professional, independent and unbiased opinion to assist our clients with their adjudication challenges or to provide an external source to comply with ERISA/DOL or state laws. MRIoA reviews cases prospectively, concurrently and retrospectively for: Medical Necessity, Appropriate Treatment, Experimental Procedures, Utilization Frequency, Appropriate Hospitalization, Formulary Criteria Review, Pre-Existing Conditions, Injury Causation, CPT Coding, Level of Disability, Provider Fees, Outpatient Facility Fees, and all Diagnostic Testing and Charges. MRIoA has provided state-level external review in many states since 2001. MRIoA is also contracted with hundreds of clients to offer Federal External Review under the ACA.