Healthcare Review Services

Supporting fair, accurate, and defensible healthcare decisions.

Independent reviews you can stand behind.

As a URAC-accredited Independent Review Organization (IRO), MMRO delivers impartial, evidence-based healthcare reviews that support accurate, defensible clinical decisions.

Appeals and Dispute Resolution

State and Federal External Appeals
Internal Appeals

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Medical Necessity and Utilization Reviews

Utilization Reviews
Preauthorization Reviews

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Specialized Healthcare Reviews

Workers’ Compensation Reviews
Long-Term Care Reviews
Quality of Care Reviews

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When a dispute moves beyond a health plan's internal process, MMRO provides impartial, independent reviews in accordance with federal and state requirements.

Appeals and Dispute Resolution

URAC-accredited Independent Review Organization

ACA and ERISA compliance

Independent physician review

Evidence-based determinations

State and Federal External Appeals

Internal Appeals

MMRO provides independent clinical review of disputed coverage and claim determinations to ensure decisions are evaluated on their medical merits.

Board-certified physician reviewers

Objective review of medical evidence

Current evidence-based standards

Defensible clinical rationale

Medical Necessity & Utilization Reviews

Utilization Reviews

Utilization reviews assess whether care is medically necessary, appropriate, and delivered in the right setting — and they can take place at any stage of the care journey.

Preauthorization Reviews

Preauthorization reviews determine whether a requested service, procedure, treatment, or medication is medically necessary before it is delivered.

Prospective reviews (before care is delivered)

Concurrent reviews (during care)

Retrospective reviews (after care is completed)

MCG and InterQual-based criteria

Board-certified physician review

Evidence-based clinical criteria

Review of medical history and plan provisions

Prevention of unnecessary or inappropriate care

Timely determinations

Support for quality care and efficient operations

Specialized Healthcare Reviews

Workers’ Compensation Reviews

Workers’ compensation cases sit at the intersection of clinical care, employment, and regulatory compliance — and each one demands a careful, impartial review.

Jurisdiction-specific compliance

Long-Term Care Reviews

Long-term care reviews evaluate whether a member's condition warrants ongoing care services such as skilled nursing facility care, home health services, assisted living support, or custodial care

Skilled nursing assessments

Home health evaluations

Assisted living reviews

Level-of-care determinations

Causation assessments

Treatment necessity reviews

Quality of Care Reviews

Quality of care reviews investigate the appropriateness, safety, or effectiveness of care that has already been delivered — whether raised by a member, provider, regulator, or the plan itself.