We provide an end-to-end solution for denials; we develop appeal reports to clinically justify treatments from the evaluation of patient medical history and medical necessity based on medical guidelines.
We handle the development of appeal reports for a wide range of denials :
- Diagnostic studies (X-rays, MRIs, CT scans, EMGs etc)
- Psychology consults and cognitive behavioral therapy
- Procedures (spinal injections, sympathetic blocks, spinal cord stimulators etc)
- PT, chiropractic care, aqua therapy, massage, acupuncture, weight loss programs
- DME, surgical consults
- Medications etc
- High approval rate – over 70% approvals on the appeal with significant increase in direct (time spent on appeal) and indirect revenues (from authorized treatments)
- Our service is end-to-end; includes identifying missing data, reviewing medical records, calling patients (if needed) to gather additional information and developing a detailed appeal report based on ODG and MTUS guidelines
- Is fully secure and HIPAA compliant with quick turnaround times to maximize revenue and reduce AR days
- Is seamless to the client with quick on-boarding; can get started on ‘appeals’ within a week