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Why Is a Medical Review Officer Calling Me?

If a medical review officer (MRO) is trying to reach you after a drug test, the lab result was probably not a plain negative. That doesn't mean you failed. The MRO is a physician whose job is to check for a medical explanation, such as a prescription, before the result is final. Calling back quickly is the best thing you can do. This guide explains why MROs call, what the call is like, what to have ready, and what can happen if you don't call back. It is general information, not medical or legal advice.

Updated October 24, 2026 · Checked against the official sources listed at the end

Why the MRO is calling

On Pact's $40 10-panel, a lab result that isn't negative goes to the MRO. The MRO contacts the person tested to ask about prescriptions before the result is final. Pact's MRO is DRS.

Federal DOT rules describe the same step for DOT tests. When the lab reports a confirmed positive, adulterated, substituted or invalid result, the MRO must contact the employee directly and confidentially to see whether they want to discuss it (49 CFR 40.131(a)). Pact's online test is non-DOT, so those rules don't govern it, but they show how MRO review is meant to work.

Who the MRO is

Under DOT rules, an MRO must be a licensed physician, either a Doctor of Medicine or a Doctor of Osteopathy (40.121(a)). The MRO is not your employer and not the lab. The MRO reviews the result and decides whether there is a legitimate medical reason for it. Our guide to MRO review covers the MRO's role in more depth.

Is the call real?

Pact doesn't publish the MRO's caller ID here. If you're not sure a call is real, don't give medical details yet. Call Pact at 901-666-6970 and ask, or email support@pactcompliance.com. Pact follows up by email the same business day.

Your Pact test was paid at checkout. If a caller asks you to pay for your drug test, especially with a prepaid card, stop and check with Pact first. Quest's own site warns that a prepaid card to cover drug testing fees is generally a sign of a fraudulent job scheme.

What the call is like

Under DOT rules, the conversation follows set steps. Expect something similar:

Staff may call first to set up the talk. Staff can tell you to have prescription information ready, but they must not gather medical information themselves (40.131(b)).
The MRO tells you what the lab found, explains the process, and says the decision will be based on what you tell them (40.135(a) and (b)).
Under DOT rules, the MRO also warns that certain safety-related medical information may be shared with third parties without your consent (40.135(d)).
You get a chance to give a medical explanation in every case (40.137(b)).
The MRO may contact your doctor, and may check with your pharmacy that a prescription was filled (40.141).
The MRO must not question whether your doctor should have prescribed the medicine (40.137(a)).

What to have ready

The name and dose of each prescription you take, as on the label.
Your prescriber's name and phone number.
Your pharmacy's name and phone number, and fill dates if you have them.
Over-the-counter medicines and supplements you took before the test.
Under DOT rules, the burden is on you to show a medical explanation. The MRO can allow up to five days to get records (40.137(c)).

If you miss the call

Call back as soon as you can. Under DOT rules, the MRO's office makes at least three tries over 24 hours at the phone numbers on the custody form. If that fails, the MRO asks the employer's contact to tell you to call the MRO, without saying why (40.131(c)).

Under DOT rules, the MRO can finish without talking to you if you decline to discuss the result, if more than 72 hours pass after the employer reached you, or if no one can reach you within ten days (40.133(a)). For a non-DOT Pact order, ask Pact how long you have. Either way, waiting doesn't help you.

What the MRO can and can't accept

A legally valid prescription can be a legitimate medical explanation. Under DOT rules, if there is one, the MRO verifies the test as negative (40.137(d)).

DOT rules also list explanations an MRO must not accept (40.151). These include a doctor's recommendation for a Schedule I drug under a state "medical marijuana" law, hemp or other non-prescription marijuana products such as CBD, coca tea, and stories of unknowing use, like a spiked drink. Pact's non-DOT MRO decides each case, so don't assume an explanation will work. Tell the MRO the truth and give them what they ask for.

What happens next

After the review, the MRO reports a final result. Under DOT rules, the options are negative, cancelled, or positive or a refusal to test (40.129(a)(5)). On a Pact order, the result is reported to you and to the employer or program named at checkout. Don't stop or change a medicine because of a drug test. Talk to your prescriber.

Common questions

Does a call from an MRO mean I failed?

No. It means the lab result wasn't a plain negative and the MRO is checking for a medical explanation before the result is final.

How long do I have to call the MRO back?

Call as soon as you can. Under DOT rules, the MRO can verify without you if more than 72 hours pass after the employer told you to call. For a non-DOT Pact order, ask Pact.

How do I know the MRO call is real?

If you're not sure, call Pact at 901-666-6970 before you share medical details. A Pact test is paid at checkout, so be wary of anyone asking you to pay for your test.

Will the MRO tell my employer what medicine I take?

Under DOT rules, the MRO warns that some safety-related medical information may go to third parties. For how a non-DOT Pact report is worded, ask Pact.

Who is Pact's MRO?

DRS. MRO review is included in the $40 price of Pact's 10-panel.