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Regulatory Compliance

MRC offers a suite of services to companies subject to mandatory insurer reporting under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act (MMSEA Section 111).

The costs for noncompliance with MMSEA Section 111 are substantial, which is why MRC helps our clients to tackle regulatory compliance and avoid costly fines down the line.

  • CMS Reporting Agent – MRC offers a full reporting agent service. This end-to-end process includes Medicare eligibility verification through the CMS query system, data collection, and timely and accurate reporting.
  • RRE Registration – MRC helps to simplify the regulatory compliance process. MRC will complete the registration of a Responsible Reporting Entity (RRE) on behalf of a RRE.
  • CMS Data Development – Save time when it comes to regulatory compliance processes with MRC. Our team will take care of the development and implementation of CMS-required data file submission on behalf of a RRE.
  • CMS Data Management – Let MRC handle the management of CMS data exchange for settlement reporting.
  • Data Collection – MRC will help you optimize your regulatory compliance processes with the collection and capture of CMS-required data points and/or ICD-10 codes into custom fields.
  • Opposing Counsel Services – MRC will identify any incomplete data fields and/or missing authorizations and resolve missing data by coordinating communications directly with the claimant’s attorney.

Utilization Review

MRC’s effective Utilization Review services help health care insurers and hospitals by critically evaluating medical necessity.

We provide criteria-based evaluation of the medical necessity for admission, delivering significant bottom-line results through effective outsourced solutions. MRC helps hospitals analyze and manage the important task of properly statusing Medicare cases as they enter your doors.


  • Precision – With MRC’s Utilization Review, your team will classify admission status correctly the first time.
  • Responsiveness – MRC’s remote utilization nurse workforce is the largest in the industry and is there to provide support 24/7.
  • Coverage – MRC’s highly-experienced RNs provide critical coverage during those hours staff nurses may be overextended, such as on nights and weekends.
  • A Bird’s-Eye View – As an independent third-party, our feedback in the review cycle helps facilitate awareness and discussion around root issues that may become more challenging.

MRC’s utilization review solution serves as an extension of your case management department. With our utilization review service, we provide:

  • Analyses performed to meet InterQual criteria standards
  • A customized work product created by our expert Utilization Review nurses
  • A national network of physician advisors for secondary review
  • Condition Code 44 compliance

Chart Retrieval & Abstraction

MRC’s Chart Retrieval & Abstraction service provides clients with a comprehensive view of a patient’s medical history and all the vital, relevant information pertaining to the project at hand.

Our team of medical record specialists, nurses, and physicians retrieve, redact, abstract, and even adjudicate charts of any type. This provides clients with a strategic advantage in the form of advanced medical knowledge that is distilled into an understandable, customized work product.

MRC’s Chart Retrieval & Abstraction service includes:

  • Chart retrieval order form development.
  • Provider confirmation research.
  • Chart requests and follow-up activities.
  • Hosting of charts in MRC’s online portal, WiseFiles.
  • Redaction of key components identified by the client.
  • Abstraction to summarize vital information identified by the client.

Medical Literature Research

MRC offers comprehensive Medical Literature Research and Analysis by MRC nurses who are skilled in research techniques and deeply familiar with scientific and medical terminology as well as legal proceedings.

Clients who utilize Medical Literature Research will benefit from a review and analysis of published clinical research findings.

This service takes many forms, including:

  • researching the medical “precedent,” including the standard of care, best medical practices, etc.
  • researching the full extent of medical damages and the plausibility of causation
  • researching chemicals for exposure routes, causation to illnesses, symptomatology and more, helping to prove or disprove liability
  • the preparation of “learned medical treatises” on specific medical issues; nurses will compile the results of intensive research specific to an individual case or litigation with cited sources and references, which can then be used by the litigation team as a reliable source of facts

Medical Call Center

MRC’s legal & medical call center operates on the same high levels of excellence, ethical standards, and quality that characterize all of our service lines.

Every call center project is customized to meet the individual needs of the client.

MRC’s professional call center staff:

  • Handles highly complex calls
  • Establishes rapport between the caller and MRC’s client
  • Serves as backup to non-specialty call centers

Data Mining

MRC’s Data Mining service provides counsel with the most complete picture of a plaintiff’s medical history, ensuring all sources of case evidence are identified and examined.

This process includes the fastidious review of plaintiff fact sheets, medical records, and all other available sources of information to identify and locate all providers of care.

Strengthen Your Strategies

Request a free demo from MRC and experience the strategic difference with our innovative suite of solutions.