Corporate Integrity Agreement (CIA) Support

EdiPhy Advisors provides independent review of medical necessity determinations to assist providers who are operating under a Corporate Integrity Agreement. EdiPhy Advisors is URAC-accredited as an Independent Review Organization and employs physician advisors who maintain relevancy and accuracy with the changing landscape of legal and regulatory requirements in healthcare compliance.

As a URAC-accredited Independent Review Organization, EdiPhy Advisors is committed to providing a fair and impartial medical peer review process. The URAC accreditation process is designed to assure that Independent Review Organizations are free from conflicts of interest, establish qualifications for each physician performing independent medical peer review, address medical necessity issues, are transparent in their processes and have reasonable time periods for standard and expedited peer reviews and appeals processes.

To support compliance with Corporate Integrity Agreements, the use of EdiPhy Advisor’s IRO Services enables clients to reduce their liability through the unbiased expertise of independent, Board Certified Specialists and Subspecialists.

This service is critical for providers who are operating under a CIA.

  • Claims Review for Discovery Sample (and Full Sample if needed).
  • Annual Reports as required by the Office of Inspector General (OIG).

EdiPhy Advisors understands and is experienced with the requirements of Claims Review, reporting of overpayments and annual reporting requirements. EdiPhy Advisors uses appropriate statistical software to select the Discovery Sample and Full Sample (when needed).

EdiPhy Advisors completes the Claims Review report per required claims review methodology, statistical sampling documentation, and the claims review findings (to include both narrative and quantitative results). EdiPhy Advisors staff possess a clear understanding of the requirements and deliver thorough reviews and analysis in order to accurately complete the reviews and reports.