Medical Management Services
EdiPhy Advisors, LLC assists hospitals with the all-important determinations of whether patients are inpatients or outpatients (with or without observation services). EdiPhy Advisors employs a strong team of board certified and actively practicing physicians and a team of licensed nurses who are dedicated to maintaining currency and accuracy relative to healthcare law, rules and regulations. EdiPhy Advisors is accredited by URAC as an Independent Review Organization (IRO) and holds as accreditation from the National Committee for Quality Assurance (NCQA) in Utilization Management. Our work is accomplished through state of the art technology and a highly competent staff.
EdiPhy Advisors also conducts independent reviews of medical necessity determinations for preauthorization of medical procedures, for internal appeals, for self-insured health plan external reviews and others as required by the Patient Protection and Affordable Care Act (PPACA). EdiPhy Advisors also has experience as an IRO for providers operating under a Corporate Integrity Agreement and also serves as the IRO for six state exchanges.