The service

The work, stage by stage

We start where the money is — the denials already sitting in your queue. We pull them, appeal them, file them and follow them to a decision. Once we know what your payers enforce, the same work moves upstream to the authorizations that haven’t gone out yet.

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Example output

Illustrative

Denial summary

Request denied because the non-biologic DMARD trial duration was not documented; the policy requires a 3-month trial at the maximally indicated dose with a recorded outcome.

Supporting evidence

RA diagnosis, RF & anti-CCP positive
Methotrexate 25 mg weekly documented

Missing evidence

Explicit 3-month trial duration and outcome

You also receive an editable draft appeal that rebuts the denial and flags missing items in brackets — never invented.

What we do

Three stages of the same case

Listed in the order we take them on, not the order they happen. A denial is where we prove ourselves, and where the return is immediate.

If it's denied

Denial recovery

Once you've granted delegated access, we pull the denial and the clinical record ourselves. We read the letter for the real denial reason, pull that payer's published policy, separate the evidence your record supports from what it doesn't, and draft the appeal grounded only in documented facts. You approve it; we file it and follow it to a decision.

What comes back

The actual reason the payer denied, read straight from their letter
The specific criterion the denial turned on, cited to that payer's policy
What the policy needed that your notes don't yet substantiate
A drafted appeal you own and edit — gaps flagged, never fabricated
The appeal filed as your delegate once you approve it, then chased to a decision

Before you submit

Submission readiness

Once we are working your denials, we know what your payers enforce. We grade the next case against that payer's policy before it goes out, and tell you what to close first.

What comes back

Which criteria the record already supports, and which it doesn't
A denial-risk band from the real met-vs-missing picture — never a fabricated score
A cover sheet, with any field the notes don't support left blank and flagged
A drafted letter of medical necessity, every clinical claim traced to your notes

Before the case

Payer rules, up front

For a given drug, diagnosis and payer, what that payer actually requires — drawn from their policy text, not from generic guidance or someone's memory.

What comes back

The coverage criteria for that drug and indication
The documentation to assemble before submitting
The step-therapy sequence the policy expects, and in what form
Where this request usually fails, so it can be pre-empted

Preparing authorizations is part of the service once we are working your denials. It is never billed as its own line.

Coverage

Where our policy corpus is verified

Every criterion we cite is read from a payer's published policy and checked against the source document. We will tell you plainly if your payer or drug isn't covered yet — and adding one is content work, not a product change.

Specialties

Rheumatology
Dermatology
Gastroenterology
Hematology
Endocrinologyone drug today — pediatric growth hormone deficiency

Payers and PBMs

Aetna
Cigna
UnitedHealthcare
CVS Caremark
Express Scripts

Coverage is not uniform across every specialty and payer pairing. Tell us the drug and the payer and we will confirm before you send anything.

Why the output holds up

Work you can put in front of a payer

An appeal that overstates the record costs credibility we don't get back. The method is built around that, not around sounding confident.

Grounded in real payer policy

We work from that payer's actual published criteria, injected whole — not summarised into a black box, and not recalled from memory.

It never invents a clinical fact

Extraction and drafting are two hard-separated stages. A claim that isn't in your notes has no path into anything we hand back.

Nothing identified without a BAA

The opening audit runs on closed, de-identified cases, which need no BAA. No identified patient record is processed until the agreements are signed.

How we keep the output accurate & handle data

Start with five denials you've already closed

Send five denied specialty cases, de-identified. We'll tell you which we judge were winnable and draft the appeal for the strongest. Free.

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