Internal IRO

EdiPhy Advisors, LLC

Internal IRO for Insurers and their Members

This service enables healthcare providers and health insurance plans to comply with applicable regulations and guidelines through appropriate application of medical necessity criteria.

  • Pre-authorization / first line medical necessity certification or denial.
  • Concurrent review of medical necessity and/or patient status.
  • Internal appeal of adverse benefit decision.

The use of EdiPhy Advisors’ IRO Services helps clients to reduce their liability through the unbiased expertise of external, Board Certified Specialists and Subspecialists. In addition, these services assist in the development & implementation of standardized medical criteria prior to authorization.

EdiPhy Advisors’ IRO services also support clients in improving member satisfaction and customer service through the provision of unbiased, expert, well-written and evidence-based adverse benefit determinations.