This service enables healthcare providers and health insurance plans

to comply with applicable regulations and guidelines through appropriate

 application of medical necessity criteria.

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• Pre-authorization / first line medical necessity certification or denial.

• Concurrent review of medical necessity and/or patient status.

• Internal appeal of adverse benefit decision.​

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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.

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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.