Internal IRO for Insurers and their Members
EdiPhy Advisors, LLC
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