Terms of Use

Paveo is a service. We work denied specialty drug claims: we read the denial, find the criterion it turned on in the payer's published policy, draft the appeal grounded in your own clinical record, and — on live cases — file it as your delegate and follow it to a decision.

Paveo is not medical advice, not legal advice, and not a guarantee of coverage, payment or any outcome. Clinical decisions remain with your clinicians, and we are not a party to your contracts with any payer.

Every appeal is approved by a named person on your side before it is filed. That approval is recorded against the exact content it approved, so what went to the payer is always the thing your reviewer said yes to.

Our operators file under delegated access you grant us. No Paveo software submits anything to a payer on its own, and there is no automated submission of any kind.

You may revoke delegated access at any time, effective immediately. If you do, we stop filing and hand back the state of every open case.

That the records you give us access to are the records for the case, and that you have the authority to share them with us for this purpose.

That granting us delegated portal access is permitted under your agreements with the payer and your own internal policies. We cannot make that judgement for you.

For the free audit: de-identifying every document before you send it. We will tell you exactly what to remove. We cannot de-identify on your behalf, because to do that we would have to receive the protected health information first — which is the one thing the audit exists to avoid.

No identified patient record reaches us before a Business Associate Agreement is signed. If one does, we delete it and ask for a clean copy rather than work from it.

The audit is five closed, denied, de-identified cases, free. You get our judgement on which were winnable, the exact payer criterion each one turned on, and a drafted appeal for the strongest — and you keep all of it whether or not you go further with us.

It is a retrospective assessment of cases that are already closed. Nothing from an audit is filed with a payer.

You pay when we win, on the unit that fits how you are paid. Nothing else is invoiced — there is no licence, no seat, no subscription, no minimum and no volume commitment.

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

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

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, and it is the outcome we worked for.

Where the fee is a percentage, the recovered claim is the amount the payer actually allows on the reprocessed claim — not billed charges, and not the list price of the drug.

If we disagree about whether a case was won, the payer's own written decision settles it — not our records and not yours.

We do not bill for:

A pilot runs for 30 days at the normal rate for your segment, with no contract. You can stop at any point, and you pay only for the denials we overturn within the 60-day window above.

What the pilot concedes is terms, not price. We do not give away free live appeals, and there is no discounted pilot rate below the fees above.

Each side keeps the other's confidential information confidential and uses it only to run the engagement. For patient information specifically, the Business Associate Agreement governs and takes precedence over this section.

Your records, and the appeals and supporting documents we prepare for your cases, are yours. You may use, file, edit and keep them without restriction.

Our software, prompts, methods and the payer policy corpus we build remain ours. Nothing in an engagement transfers them, and access to our output is not access to them.

We perform the service with reasonable skill and care, using the payer's published criteria and your own documentation. We will tell you plainly when we judge a case unwinnable, and why.

We do not guarantee that any appeal succeeds. Coverage decisions are the payer's, and no one who tells you otherwise about specialty drug appeals is being straight with you.

The website itself is provided on an “as is” and “as available” basis, without warranties of any kind.

To the maximum extent permitted by law, neither side is liable for indirect, incidental or consequential loss, and our total liability arising out of the service is limited to the fees you paid us in the twelve months before the claim.

Nothing here limits liability that cannot be limited by law, including for fraud or for death or personal injury caused by negligence.

During a pilot either side may stop at any time, for any reason. After that, termination is as set out in your agreement.

On termination we invoice for wins already achieved, stop filing, hand back the state of every open case, and return or destroy patient records as the Business Associate Agreement requires.

We may suspend work if we are asked to do something we believe is unlawful, clinically unsupportable, or outside what your records substantiate. We will say so rather than quietly comply.

The contracting entity, the governing law and the forum for any dispute are named in the written agreement we sign with you before any live case begins. This page governs use of the website in the meantime.

We may update these terms as the service develops; the date at the top says when we last did. Changes do not apply retroactively to work already performed under an agreement.

Questions about these terms: faiz@paveohealth.com.