From benefit investigation to external appeals, our prior authorization services and appeal management solutions cover the full authorization spectrum, helping patients gain access to the medical devices and innovative technologies they need.
We conduct thorough benefit investigation to confirm patients' insurance coverage and eligibility upfront, identifying potential coverage barriers early so they can be addressed before care is delayed.
We provide comprehensive prior authorization services, including predeterminations and precertifications, compiling and submitting clinical documentation to support approval.
Our prior authorization assistance specialists understand payer-specific requirements and ensure submissions are complete, compelling, and submitted within required timeframes, maximizing first-pass approval rates.
When a prior authorization or claim is denied, we prepare and submit internal appeals on behalf of the patient, marshaling clinical evidence and policy documentation to challenge unfavorable decisions. Payer denials are common with innovative medical technologies, but they should never be final. Our team is experienced in building strong internal appeal cases that give patients the best chance of an overturn at the payer level.
External appeals are especially effective for non-covered medical devices. Because IRO reviews are costly to payers, these appeals frequently drive positive coverage determinations, making them a powerful tool in the patient access toolkit. We manage this process of submitting external appeals to Independent Review Organizations (IROs).