Review Services

MPRO adheres to an established and proven independent review process comprised of well-defined sub-steps and decision points to complete the review. MPRO provides a variety of independent review services, including:

Quality and Utilization Management

MPRO’s utilization management program performs traditional Quality and Utilization Management (UM) as well as customized focused reviews on client specified cases. Our highly qualified and experienced staff can customize our UM services to meet your needs:

• Pre-certification, concurrent review, and retrospective review
• Medical necessity of care settings, procedures, services and pharmaceuticals
• Experimental reviews
• DRG validation/billing
• Appeals
• Length of stay
• Inter-rater reliability
• Inpatient/outpatient audits
• Review of day and cost-outliers
• Review of short-stay admissions
• CPT validation/outpatient coding

External Review

MPRO specializes in appropriate utilization of health services and review of quality of care that meets practice guidelines. Our reviews offer the depth of expertise and experience to ensure that our clients receive timely, high-quality, objective reviews:

• Focused quality review, quality of care review
• External appeals
• Medical necessity, case consultation

Independent Reviews

MPRO is Michigan’s leading independent review organization with over 25 years of experience. MPRO provides a wide array of diversified medical management services. Recognized for its integrity and objectivity, MPRO is an established leader in Medicare, Medicaid, review and various other health care industries. MPRO provides high quality, comprehensive and objective utilization management, and independent review services to hospitals and health plans nationwide. MPRO is URAC accredited in Health Utilization Management and Independent Review.

MPRO’s independent review services are tailored to meet your organization’s needs. Professional integrity, reliability, and strict attention to detail by medical review specialists experienced in all areas of medicine sets us apart from the typical review organization. Whether it’s a few cases or many, our highly qualified and experienced staff can effectively customize a service to meet your needs.

MPRO provides a variety of medical management services including:

• Quality and Utilization Management
• Independant External Peer Review