Fixed-Fee Physician Review for Denials and Federal IDR
Begin with a structured evaluation, commission an individual deliverable when needed, or reserve recurring physician-review capacity. Scope and final fee are confirmed before records are transferred. No hourly billing.
Send a de-identified summary. Clinovian will identify the appropriate deliverable and confirm scope, turnaround, and fixed fee before records are transferred.
3-Case Denial Evaluation
A one-time introductory evaluation for new client organizations. Designed to test clinical fit, deliverable quality, and workflow compatibility before any recurring commitment.
Standard individual pricing begins at $1,350
- Three standard-scope denial cases reviewed by physician
- The appropriate physician deliverable for each case
- Clinical evidence and criteria mapping
- Documentation-gap identification
- Cross-case denial-pattern summary
- One 30-minute findings discussion
- One invoice
Available once per new client organization as an initial workflow evaluation. Additional matters are priced individually or through Recurring Physician Review Capacity.
Start a 3-Case Evaluation →3-Dossier IDR Evaluation
A one-time introductory evaluation for new client organizations. Three standard-scope, clinically distinct Federal IDR dossiers with physician-authored clinical synthesis designed to fit your existing procedural and filing workflow.
Standard individual pricing begins at $2,250
- Three standard-scope, clinically distinct dossiers
- Record-cited clinical evidence mapping
- Acuity, complexity, and resource-intensity narrative
- Additional-circumstance matrix
- Evidence-gap and contradiction check
- Editable clinical language for client-controlled submission
- One 30-minute findings discussion
- One invoice
Available once per new client organization. The client retains control of eligibility, coding, batching, deadlines, offers, certification, and filing.
Start an IDR Evaluation →For many high-value denials, the amount at stake in one case may exceed the cost of the complete three-case evaluation.
Fixed-fee physician deliverables available individually or as part of a package.
| Service | Starting fee | Turnaround |
|---|---|---|
| P2P Preparation Brief | From $300 | 24–48 hours |
| AI Appeal Clinical QA | From $250 / appeal | 24–48 hours |
| Standard Physician Denial Review | From $450 | 48–72 hours |
| Federal IDR Clinical Dossier | From $750 / dossier | 3–5 business days |
| No-PHI AR Audit | Quoted individually | 72 hours |
AI Appeal Clinical QA: volume pricing available through Recurring Physician Review Capacity.
Complex or extensively reconstructed matters — scope-dependent
Includes complex DRG downgrades, multi-issue admissions, extensive ICU or surgical records, rebundling disputes, unusually large record sets, and cases requiring substantial clinical reconstruction. These are quoted individually after a de-identified scope review.
Standard case definition. Standard pricing assumes one primary denial issue, one clinical episode, an ordinarily organized record set, and one agreed physician deliverable. Multi-issue cases, extensive chart reconstruction, complex DRG analysis, or unusually large records are quoted separately. One dossier means one agreed, clinically coherent narrative and evidence scope. A client-designated batch is not automatically treated as one dossier; item count, record volume, and clinically material variation are considered when confirming scope and fee.
Recurring Physician Review Capacity
For hospitals, RCM organizations, IDR companies, and AI appeal vendors with ongoing review volume. Arrangements may include reserved capacity, suitability triage, white-label delivery, consolidated invoicing, and volume pricing.
From five deliverables per month
Pricing is based on work mix, expected volume, and turnaround requirements. Scoped after a de-identified review of the recurring case profile.
Included in recurring arrangements
Suitability triage on incoming cases. A prevention note on every memo. Outcome tracking at 60–90 days where disposition and payment data are supplied by the client. Quarterly Impact Summary based on cases reviewed and outcome information supplied by the client.
White-label available
RCM firms, denial-management companies, and AI appeal vendors can embed the desk under white-label or co-branded terms.
| Deliverable | Normal turnaround |
|---|---|
| Appealability screen | 24–48 hours |
| P2P Preparation Brief | 24–48 hours |
| AI Appeal Clinical QA | 24–48 hours |
| Standard Physician Denial Review | 48–72 hours |
| Observation vs. Inpatient Defense | 5–7 business days |
| DRG-Downgrade Challenge | 7–10 business days |
| Post-Acute Denials (SNF / IRF / LTACH / Home Health) | 5–7 business days |
| Federal IDR Clinical Dossier | 3–5 business days after receipt of the complete agreed record |
| No-PHI AR Audit | 72 hours |
Turnarounds are commitments, not estimates. If complexity will require additional time, that is communicated at the scope stage before you commit. Expedited review by prior agreement.
All fees are confirmed after a de-identified scope review and before records are transferred. Starting fees assume a standard record set and one primary clinical issue. Substantial chart volume, multiple clinically distinct issues, urgent delivery, or unusually complex reconstruction may change the final fee. No hourly billing and no per-page charges.
Fixed-fee, not hourly
Every engagement is priced by deliverable or project scope — never by the hour, per page, or per case at commodity rates.
Complexity-driven
A complex DRG-downgrade dispute with full chart reconstruction is scoped differently than a standard medical-necessity review. The work drives the price.
Process fees separate
Federal administrative and certified-IDR-entity fees are paid and managed by the client and are not part of Clinovian's physician-review fee.
Send a de-identified case summary.
Clinovian will confirm fit, scope, turnaround, and fixed fee before records are requested.