Company
Transforming the relationship between healthcare payers and providers by fairly and objectively resolving conflicts
Third Party Review Innovations (TPRI) offers an unbiased resolution process for payer and provider disputes regarding medical claim status. TPRI was founded based on experience in working with both payers and providers during claim status disagreements. TPRI’s goal is to be a source of unbiased and independent decisions based on information available in the medical record and the standards agreed upon by the parties.
We love what we do and strive for:
Objectivity. We look at things as they are, black and white and without bias.
Integrity. We tell it like it is, with professionalism, objectivity, and respect.
Versatility. Our clients come from different viewpoints; we adapt to meet their needs first and foremost.
Creativity. We use new and thoughtful strategies to help clients work through obstacles and to improve relationships.
Respect. For ourselves, our clients, and their employees.
Ann Marie Carpenter, DO
Founder and Chief Executive Officer
Dr. Ann Marie Carpenter is Founder and Chief Executive Officer of Third Party Review Innovations (TPRI). Dr. Carpenter, an industry veteran, brings to TPRI two decades of extensive experience leading healthcare organizations in the utilization management and compliance/regulatory space. After an extensive career of helping payers and providers in their disputes with one another, Dr. Carpenter is passionate about establishing a company with an innovative, creative, and impartial solution to the payer-provider/provider-payer relationship.
Prior to founding TPRI, Dr. Carpenter was Medical Director for ConcertoHealth, where she performed delegated utilization review for inpatient and outpatient services for payers’ Managed Medicare, Managed Medicaid, and Commercial lines of business. Before ConcertoHealth, Dr. Carpenter worked as a Medical Director at Cotiviti Healthcare, a company that enables payers to achieve accuracy across the payment continuum and improve their financial results with solutions for coding and contract compliance, and clinical appropriateness. At Cotiviti Healthcare, she helped payer clients reduce medical and administrative costs and improve operating effectiveness and compliance.
Prior to her employment at Cotiviti, Dr. Carpenter was Vice President of Advisory Services at Executive Health Resources (EHR). Dr. Carpenter’s experience at EHR includes defending hospitals by assisting compliance officers and legal counsel during OIG and DOJ investigations. At EHR, she assisted hospitals with onsite support of length of stay management and utilization management. Dr. Carpenter also had a high success rate in appeals for both inpatient and outpatient denials. Dr. Carpenter was instrumental in the development the physician advisor training program.
She started her career as a family practitioner at Jeffersonville Internal Medicine where she worked for over five years. In addition, she was on staff at a dozen nursing homes in the Norristown, PA area, and Norristown State Hospital.
Dr. Carpenter is an expert in medical necessity and peer review and has a vast knowledge of Medicare and Medicaid regulations. Over the years, she has been very active in the industry and was one of the founding directors of the American College of Physician Advisors (ACPA).
Dr. Carpenter received her doctorate in Osteopathic Medicine from Philadelphia College of Osteopathic Medicine and completed her internship and residency in Family Practice at Mercy Suburban Hospital in Norristown, PA.