About

A physician-led clinical escalation desk for denial and appeal operations.

Clinovian exists because there is a gap between what a coder, CDI specialist, or AI appeal tool can argue — and what requires genuine physician-level medical-necessity reasoning. That gap is the desk.

Leadership

Dr. Arun Kasturi, MBBS

Founder. Physician with payer-side utilization-management review experience across 3,000+ U.S. commercial claims under InterQual and MCG licensed criteria frameworks. The operational experience of applying criteria, constructing medical-necessity determinations, and evaluating clinical evidence from the review side is the foundation of the desk's criteria-mapping methodology — and what distinguishes the output from standard appeal narrative.

Additional background in pharmacovigilance (ICSR medical review, adverse-event assessment, aggregate safety reporting) and clinical-regulatory methodology — relevant to the desk's pattern-intelligence and AI appeal quality-assurance work.

Pursuing LLB (law degree) and CFE (Certified Fraud Examiner) credentials — expanding the desk's capability into compliance-adjacent clinical analysis where denial patterns intersect with regulatory and legal frameworks.

Clinical review structure

The desk's clinical escalation methodology operates through a structured review process designed for consistency, quality, and licensure compliance:

01

Physician-led criteria mappingEvery case is reviewed by a physician with direct experience in how payer UM reviewers evaluate criteria. The clinical evidence is mapped to the denial rationale and the applicable criteria pathway — producing the argument structure, not just the clinical narrative.

02

Fixed-format deliverableThe output is a structured 12-section memo designed for handoff to the client's appeal writer or submission team. The format is consistent across all cases — eliminating variability and ensuring every section is addressed.

03

U.S.-licensed panel reviewer engagementWhere a case requires formal U.S.-licensed clinical sign-off — for external appeal submissions, peer-to-peer calls, or client-specific licensure requirements — the desk engages a U.S.-licensed panel reviewer with relevant specialty credentials. Panel involvement is scoped and disclosed at engagement, and reflected in pricing.

04

Pattern intelligence layerEvery case is tagged with denial-pattern metadata. Over time, the aggregate intelligence identifies payer-specific denial strategies, documentation gap patterns, and criteria-interpretation trends that feed back into both the desk's methodology and the client's operational improvement.

This structure separates the clinical reasoning methodology (physician-led criteria mapping) from the licensure requirement (U.S.-licensed sign-off where needed). Both are disclosed transparently. Both are reflected in engagement scoping.

How the practice operates

Physician-authored

Every escalation memo, P2P brief, and clinical QA review is authored by a physician — with coder, CDI, LNC, and AI workflows complemented rather than replaced.

Structured deliverables

Fixed-format outputs designed for handoff — your appeal writer receives the clinical argument, not a consulting memo they need to interpret.

Pattern intelligence

Every case feeds a proprietary denial-pattern library. Over time, the aggregate intelligence becomes as valuable as the individual memos.

Get started

The work speaks for itself.

Start with a 3-case pilot. See the output. Then decide.

Start a Pilot View Sample Work