77 questions, answered straight

Two things. Delegated access to the payer portals your team already uses, and one named person on your side who approves finished appeals.

Delegated access is the slower of the two to arrange, because it usually needs your portal administrator. Raise it early.

It is the same mechanism a payer portal already provides for letting a colleague or an outside biller act on your behalf. You add our operator under your organization's account, with the permissions you choose.

It is what lets us pull the denial, file the appeal and check status ourselves. Without it we would have to hand work back to you at every step, which is the thing we are removing.

At any time, effective immediately, from inside your own portal. There is no notice period, nothing to uninstall, and no contract clause that delays it.

If you revoke it, we stop filing and hand back the state of every open case.

No, and this is not a setting that could be switched on. There is no automated payer submission in Paveo — no portal form-filling, no EDI, no fax robot.

A person files, as your delegate, after your named approver has signed off. That approval is recorded against the exact content it approved.

A named person at your organization, chosen by you. Nothing is filed without it.

It is one decision on finished work, not a second pass of the work. If the appeal is right, it is a yes.

We follow the case to a decision — checking status on a schedule and handling what the payer comes back with. Nobody on your team sits on hold.

You get the outcome and the payer's written decision.

We tell you plainly, and why. Usually it is because the record does not substantiate a criterion the policy requires, and we will say which one.

We would rather hand you a shorter honest answer than file a weak appeal. An appeal that overstates the record costs credibility with that payer, and that credibility is yours, not ours to spend.

We do not publish a turnaround time, because we do not yet have enough live cases to quote one honestly. When we have measured it, we will say so.

What we can tell you is the shape: our part is fast, and the wait is the payer's decision clock, which we do not control.

Both, in that order. Denials first, because that is where the money already is and where the payer's criteria decide the outcome.

Once we are working your denials we know what your payers actually enforce, so we prepare the authorizations that come after. That is included in the service and never billed separately.

The real reason the payer denied, read from their letter. The specific criterion it turned on, cited to that payer's published policy. What the policy required that your notes do not yet substantiate. And a drafted appeal you own and can edit.

On live cases, the filed appeal and the payer's decision as well.

$199 per overturned denial if you are a specialty pharmacy dispensing under the pharmacy benefit. 8% of the recovered claim if you are a clinic or practice doing buy-and-bill or in-office infusion.

Nothing otherwise. No licence, no seats, no subscription, no minimum and no volume commitment.

Because the two customers lose money differently. A buy-and-bill practice bought the vial before reimbursement was certain, so a denied claim has an unambiguous dollar amount on it and a share of the recovery is coherent.

A pharmacy dispensing under the pharmacy benefit has no single claim value to take a percentage of, and a percentage of a drug's price would eat the margin on the fill. So that side is a flat fee.

The two are not the same amount on a large claim, and we would rather say so than have you notice. On a claim the payer settles at $8,000 the buy-and-bill fee is $640 against a pharmacy's $199. The buy-and-bill customer already spent the money on the vial, so the recovery is larger and unambiguous, and the fee follows it.

A denial we appealed is overturned when the payer issues a written decision approving the previously denied drug — in whole or in part — within 60 days of the date we file the appeal.

A partial approval counts: a lower quantity, a shorter duration or a different site of care still restores coverage that was denied.

Because an open-ended definition is an argument waiting to happen. Without a cutoff, an approval your own team obtained months later could arrive looking like our invoice.

The window exists to protect you from that, not to protect our fee.

A case the payer decides in your favour without our appeal ever being filed. An approval on a fresh authorization we did not appeal. A decision that lands after 60 days — unless you ask us to keep pursuing it and we agree in writing first. An appeal your own team filed, whether or not we drafted it. Any appeal we file and lose. That is the whole point of the model. A reversal the payer later rescinds — if the overturn is undone, we credit the fee.

No to any of them. There is no charge for onboarding or implementation, no volume commitment, and no floor under the percentage — the fee is the share of what comes back, whatever that works out to.

If we win nothing in a month, you are invoiced nothing that month.

Worked through: a recovery of $1,500 pays $120; $8,000 pays $640; $20,000 pays $1,600.

The whole engagement on that denial, in one number:

Pulling the denial and the supporting clinical record ourselves. Finding the exact criterion the denial turned on in that payer's published policy. Drafting the appeal, with every clinical claim traced to your own documentation. Filing it as your delegate once your named approver signs off. Chasing the payer to a decision, so nobody on your team is on hold. Preparing the authorizations that come after, once we are working your denials.

None of it is billed separately, and prior authorization preparation in particular never is.

What you are never invoiced for, whatever happens: setup, onboarding or implementation; seats, licences or a subscription; a monthly minimum or a volume commitment; the five-case audit that starts the relationship; denials we appeal and lose.

No, and we will not. It is bundled into the service once we are working your denials.

Priced on its own it would sit against an outsourcing market advertising roughly $3 to $10 per case, which is a comparison about headcount cost rather than whether the authorization succeeds.

Monthly in arrears, for the appeals decided in your favour that month. Fees are exclusive of any applicable taxes, and payment terms are set out in your agreement.

No, and that is deliberate. What a founding partner gets is the rate locked for twelve months and priority turnaround.

A discount answers a question you were not asking. You already cannot lose money on us — a denial we do not win costs you nothing — so the risk you actually carry is whether we deliver, and terms answer that where a lower price does not.

The payer's own written decision. Not our records, and not yours.

We build to HIPAA's Security Rule requirements: tenant isolation enforced in the database, an append-only audit log, and logging designed so patient data cannot reach it. Worth knowing, because vendors are vague about it — HIPAA has no certification. No body certifies anyone compliant; it is a set of requirements you meet and can evidence.

The obligations attach when the patient data does. We do not handle identified records until the BAA is signed and our hosting has moved to HIPAA-eligible plans, which happens before your first live case. Until then the free audit runs on de-identified documents, and there is no protected health information in the system at all.

Yes — it is required before we touch an identified patient record, and we will not start live work without it.

A BAA needs a legal entity to sign it and HIPAA-tier hosting behind it. Both are real prerequisites with real cost, and we would rather tell you where we are than imply the paperwork is already done.

No. De-identified documents are not protected health information, so HIPAA's business associate requirement does not attach. This is by design — it is what lets you judge the work before either side signs anything.

Names, member ID, claim and authorization numbers, MRN, date of birth, every date element finer than the year, address and ZIP, phone, fax and email, the fax banner across the top of a page, and any barcode.

Please keep the payer, the drug and dose, the diagnosis, the denial reason, labs, and prior therapies with how long each was tried — that last one usually decides the case. Over-redaction makes the audit worthless.

Because to do it we would have to receive the identified records first, which is the exact thing the audit exists to avoid. You are the covered entity, you hold the data lawfully, and de-identification is your act.

We stop. We do not process the document and we do not quietly redact it and carry on. We tell you, delete it, confirm the deletion in writing, and ask for a clean copy.

Every page of every document is screened by a person on our side before anything is processed — not a spot check, because the identifier is usually in a page-three footer or a fax banner.

Yes — deliberately. The operator working your appeal next week needs the letter that arrived this week, so we keep what you send us, in a private store with no public link, filed under your organization and the specific case.

We keep documents for 12 months after a case closes, delete them sooner whenever you ask, and return or destroy everything when we stop working together.

The completed analysis is saved against the case so it can be reopened and audited, isolated to your organization by row-level security in the database.

No. We do not, and our AI provider does not train on it either.

Yes, and the isolation is enforced by the database itself rather than by the application remembering to filter. Every case action is also written to an append-only audit log recording who did what and when.

We are a small team working from India, and we are incorporating in the US. That matters to some buyers and not to others, so we would rather you know now than in month three of a security review.

If your organization cannot accept protected health information being accessed from outside the US, tell us on the first call. The free five-case audit runs on de-identified documents, so it is unaffected either way.

No. SOC 2 is a later step for us, driven by enterprise demand, and we would rather say so than imply a certification we do not hold.

Teams who already appeal everything and win. Teams whose volume sits mostly outside the payers and drugs we have verified. And anyone who wants a platform their staff logs into — that is a real need and it is not what we sell.

We would rather say so on the first call than take a pilot that cannot work.

They sell hours; we sell outcomes. An outsourcing firm bills whether or not the authorization succeeds, and their advertised rates put the comparison on labour cost.

We are paid only when a denial is overturned, which means a case we cannot win is our loss, not your invoice.

Those are tools your team operates, and they are good at the automated path — the authorization that goes through cleanly.

We start where that path fails. A denial that needs someone to read the payer's policy, find the criterion, and argue it against the chart is not a workflow problem, and it is not work a portal does for you.

Several prescriber-side services are free to the practice because pharmaceutical manufacturers fund them. They are genuinely useful and they start inside the prescriber's workflow.

The honest difference is whose interest is being served. A manufacturer-funded service exists to get a particular drug started. We are paid by you, only when you recover money you had already lost — which is a different question from which drug gets prescribed. And a script that reaches a pharmacy from outside those systems leaves the pharmacy's reimbursement problem exactly where it was.

You can, and for a first draft it will read well. The problem is that it does not know what your payer's policy actually says for that drug and indication, so it produces a confident letter citing criteria that may not exist.

The work here is not the prose. It is having the payer's verified criteria in front of you, checking the chart against them one by one, and being disciplined about what the notes do not support. Then filing it and chasing it.

Start with the free audit, on cases you have already lost, where nothing is at risk. Judge the work rather than the company.

After that, everything is structured so you carry as little as possible: no contract, pay only on wins, revoke our access instantly, and an appeal only goes out when your own named person approves it.

Your records and the appeals we prepared are yours. You revoke portal access from your side in seconds, and we return or destroy patient records as the Business Associate Agreement requires.

Because you were never operating our software, there is no system to migrate off and no data locked inside a product you would lose access to.

Not yet, honestly. We are early and we are not going to invent one or dress up an interview as a customer.

The free audit exists precisely because it gives you better evidence than a reference call would: our work on your own denied cases.