We win back the specialty drug denials your team doesn’t have time to appeal.
Give us delegated access to the portals you already use. We pull the denial and the notes, find the exact criterion the payer used, draft the appeal with every clinical claim traced to your own documentation, file it, and follow it to a decision. The only thing we need from your team is one approval.
A service, not software. No licence, no seats, and nothing for your team to log into.
Why it was denied
Step therapy requirement not met.
The criterion it turned on
Trial of at least one conventional DMARD for a minimum of three months, with inadequate response.
Cited to the payer’s published policy
Supported by your notes
- RA diagnosis, seropositive (ICD-10 M05.79)Chart note, p.2
- Methotrexate 20mg weekly, 4 months, inadequate responseMed history, p.1
Not supported — flagged, never written in
- TB screening within 12 monthsNot in the record — requested from the practice
Illustrative example on a synthetic case. Not a real patient.
Why denials stick
The appeal usually works. Nine in ten are never filed.
Medicare Advantage is where this is measured and public, so it is where we can prove it. Four in five appealed denials come back overturned. The nine that go unfiled are not weaker cases — each appeal simply costs well over an hour nobody has.
7.7%
of 53 million Medicare Advantage prior authorization requests were denied in 2024
KFF
11.5%
of those denials were ever appealed
KFF
80.7%
of the denials that were appealed came back partially or fully overturned
KFF
74 min
of a clinical pharmacist's time to work a single appealed authorization
AJMC
The division of labour
What we do. What your team still does.
The honest version, so there are no surprises in week one. Your team approves the work; it doesn't do the work. And nothing is ever filed that a named person on your side hasn't approved.
What we do
- Pull the denial and the clinical record ourselves, once you've given us access.
- Find the exact criterion the denial turned on, in that payer's published policy.
- Draft the appeal, with every clinical claim traced to a page in your notes.
- File it with the payer as your delegate, and chase the status until there's a decision.
- Tell you plainly when we judge a case unwinnable — and why.
What your team still does
- Give us delegated access to the payer portals you already use.
- Approve the finished appeal — one decision on completed work, not a second review of it.
- Nothing else. We do the filing, the follow-up and the record-keeping.
How it works
Six steps, from access to decision
From the denial landing in the payer's portal to a decision, with one approval from you in the middle.
You give us access
Delegated access to the payer portals your team already uses. Nothing to install, no account for your staff to create.
We find what it turned on
The specific criterion the denial turned on, cited to that payer's own published policy.
We draft the appeal
Grounded in your record. A claim that isn't in the notes is flagged as missing, never written in.
You approve it
One named person on your side says yes to a finished appeal. That approval is recorded, and nothing is ever filed without it.
We file it and chase it
We submit as your delegate and follow the case until the payer decides. You watch it move; nobody on your team is on hold to a payer.
You pay only if it's overturned
$199 per overturned denial for a specialty pharmacy, 8% of the recovered claim for buy-and-bill. No seats, no licence, no subscription — a denial we don't win costs you nothing.
How we stay accurate
Every clinical claim traces back to your own notes
An appeal that overstates the record is worse than no appeal — it costs credibility with the payer and it is not ours to spend. So the work is split in two, deliberately.
One pass only extracts
It reads your documents and records what is literally in them. It never infers, guesses, or fills a gap.
A separate pass writes
It drafts using only those extracted facts and the payer's policy text. A claim that isn't in your notes has no path into the letter.
The gaps come back to you
Missing evidence is reported as missing, with what to go and get. We would rather hand you a shorter appeal than an invented one.
After the appeal
Then we stop the next one
Working your denials shows us which criteria your payers actually enforce, and how they word them. We put that into the next authorization before it goes out. It is bundled into the service — never a separate line item.
Missing labs
Required baseline or monitoring labs absent from the packet.
Missing imaging
Imaging the policy requires to establish severity isn't attached.
Missing prior therapy evidence
Step-therapy history not documented in a payer-acceptable form.
Incorrect diagnosis coding
ICD-10 code doesn't map to the covered indication.
Step therapy not met
Required trial-and-failure sequence incomplete or undocumented.
Missing clinical documentation
Chart notes that substantiate medical necessity are absent.
The six gaps above are what biologic coordinators, PA specialists and pharmacy access managers told us they keep losing cases to.
What we are
What we are — and what we aren't
We do one thing: we win back denials. Everything else we have been asked for, we have said no to.
What we are not
- Software your team has to learn, log into, or find time to evaluate
- Another prior authorization portal
- A body shop billing by the hour to push authorization volume
- Anything that files on your behalf without a named person approving it
What we are
- A service that hands back finished appeals, not a tool that asks you to write them
- Grounded in each payer's own published coverage criteria
- Paid only when a denial is overturned
- Small enough that you talk to the people doing the work
Built from real access workflows
What access teams told us
We interviewed biologic coordinators, PA specialists and pharmacy access managers. These are the parts they told us hurt most.
“Understanding payer requirements is the hardest part of the job.”
“Missing documentation causes denials that were entirely avoidable.”
“New hires struggle for months to learn payer criteria.”
“Staff don't have time to read every policy for every case.”
Start with five denials you’ve already closed
Before any access or paperwork changes hands, judge the work itself. Send five denied specialty cases, de-identified. We’ll tell you which we judge were winnable, the exact criterion each one turned on, and draft the appeal for the strongest. Free, and it costs you about five minutes.
Closed cases only, de-identified — so this first step needs no portal access, no agreements and no BAA. We’ll send you the list of what to strip first.