Non-Concurrent Nurse Review

OneIRO provides independent, clinically focused Non-Concurrent Nurse Review services to help health plans, TPAs, PBMs, and other healthcare organizations evaluate medical necessity, appropriateness of care, and utilization after services have been rendered.

Our experienced clinical nurses review medical records against applicable plan benefits, evidence-based clinical criteria, and client-specific guidelines to deliver consistent, accurate, and defensible determinations.

Services may include:

• Retrospective Utilization Reviews

• Medical Necessity Reviews

• Inpatient & Outpatient Claims Reviews

• Post-Service Reviews

• Appeal & Denial Support

• Clinical Documentation Reviews

• Length-of-Stay & Level-of-Care Reviews

Cases requiring additional clinical judgment can be seamlessly escalated to an appropriately matched physician reviewer.