MRIoA Board-certified specialists review medical, dental, disability, and pharmacy claims. The board also reviews:

• Coding & Fee Analysis
• Plan Language Review
• Appropriateness of Treatment
• Length of Treatment
• Appropriate Hospitalization
• Fraud & Disability Review
• Pharmacy Benefit Management
• IRO/Grievance Reviews
• Quality-of-Care Reviews
• Employer Appeal and Fiduciary Review

Other Services the Physician Specialist Peer Review provides:

• Reviewer Consultation and/or Grievance/Panel Reviews:
• Written reports include reviewer's credentials
• Fees are based on physician reviewing time per case

• Support Critique’s medical professionals in all of Critique’s cost containment programs.
• Move the decision to a medically qualified third party to help reduce responsibility and maintain an arms-length relationship for complicated claims payment decisions.
• Allow the payer to make decisions within required payment guidelines.
• Allow the claims payer to make safer payment decisions.

This board of physicians reviews cases prospectively, concurrently, and retrospectively for peer review to determine: Medical Necessity, Appropriate Treatment, Experimental Procedures/DRG, Utilization Frequency, Appropriate Hospitalization, Pre-Existing Conditions, Injury Causation, CPT Coding, Level of Disability, Provider Fees, Outpatient Facility Fees and all Diagnostic Testing and Charges.


The Payer simply calls Critique’s toll free number and is connected to our Payer Coordinator assigned to them, making this a convenient and essential benefit. Average turnaround is 4 days for non-emergency care.