Know the payer's rules before you start
Pick a drug, diagnosis, and payer. Paveo returns the coverage criteria, the documentation you'll need, the step-therapy requirements, and the denial reasons that trip teams up most — so you build the case right from the first draft.
Example output
IllustrativeRequired documentation
3- Rheumatologist office notes confirming moderately-to-severely active RA
- Documented 3-month trial of a non-biologic DMARD at the maximal dose
- Treatment outcome (inadequate response, intolerance, or contraindication)
Common denial risks
2- DMARD trial under 3 months or below the maximally indicated dose
- Prescriber is not a rheumatologist and no consult is on file
Recommended actions
- Attach the dated methotrexate trial showing dose and duration
- Include an explicit inadequate-response statement
What you get
Every output, grounded in policy
Structured, reviewable, and traceable — never a black-box answer.
Coverage criteria
What this payer requires to approve this drug for this indication.
Required documentation
The exact records to assemble before you submit.
Step therapy requirements
The trial-and-failure sequence the policy expects, and in what form.
Common denial causes
Where this request typically fails — so you pre-empt it.
Recommended actions
A prep checklist tied to each policy criterion.
Grounded in real policy
Every answer is drawn from that payer's policy text — not generic guidance.
Months of payer knowledge, on day one
New coordinators take months to learn payer rules. Payer Intelligence puts that institutional knowledge in front of every coordinator, for every case — no tribal knowledge required.
Know what's missing before you submit
Help your team reduce avoidable denials and accelerate therapy initiation.