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.

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.

Certifications