Specialty-Matched Physician Peer Review

OneIRO provides independent, specialty-matched physician peer review services to help health plans, TPAs, PBMs, and other healthcare organizations make accurate, timely, and clinically sound medical necessity determinations.

Each case is assigned to a qualified physician reviewer whose specialty and clinical expertise align with the condition, treatment, procedure, or service under review. Physicians evaluate available medical documentation using applicable clinical criteria, plan guidelines, evidence-based medicine, and accepted standards of care.

Services may include:

• Medical Necessity Reviews

• Prospective & Retrospective Reviews

• Inpatient & Outpatient Services

• Procedures & Surgical Reviews

• Diagnostic Testing & Imaging

• Specialty Medications & Pharmacy Reviews

• Experimental & Investigational Treatments

• First- & Second-Level Appeals

• Complex & High-Cost Cases