Quality of Care & SIU Reviews
OneIRO provides independent Quality of Care and Special Investigations Unit (SIU) clinical review services to help health plans, TPAs, insurers, and other healthcare organizations evaluate concerns involving the quality, appropriateness, and integrity of healthcare services.
Our experienced, specialty-matched physician reviewers provide objective clinical expertise for complex cases involving potential quality-of-care concerns, questionable clinical practices, billing patterns, or suspected fraud, waste, and abuse. Reviews are based on the available medical record, applicable clinical guidelines, evidence-based medicine, and accepted standards of care.
Services may include:
Quality of Care Investigations
Fraud, Waste & Abuse Reviews
Clinical Appropriateness Reviews
Provider Practice Pattern Reviews
Medical Record & Documentation Reviews
Billing & Coding-Related Clinical Reviews
Overutilization & Unnecessary Service Reviews
Potential Upcoding & Unbundling Investigations
Provider Credentialing & Quality Concerns
Adverse Events & Potential Patient Harm
Complex & High-Dollar Claims