We sell a desk, not hours.
Structured packages with fixed deliverables, turnaround commitments, and recurring pattern intelligence. No hourly rates. No per-page pricing.
Every engagement starts with a free suitability screen.
Send a de-identified denial rationale — no PHI, no records, no commitment. A physician reviews it and returns a structured suitability verdict. The screen is complimentary. Every case, every time.
Structured suitability verdict
Every verdict — pursue or not — comes with a categorized assessment and an estimated appeal-deadline flag.
Pursue — the case has clinical merit for physician escalation. Includes estimated appeal-deadline window so your team can prioritize.
Do not pursue — returned with a reason category:
Clinically correct denial — the payer applied criteria correctly. Close the case.
Documentation gap (fixable) — the facts may support necessity, but the record doesn't capture them. Includes what to document differently on future cases.
Wrong category for escalation — billing, eligibility, or coding issue. Route to your coding team.
Expired deadline — appeal window has closed. Flag for prevention tracking.
Standard-level denial — your internal team can handle this with template language. Doesn't need the desk.
Needs more information — the clinical picture is incomplete. Returned with what's missing.
Estimated appeal-deadline window
If the denial date is included in the intake, every suitability verdict flags the estimated remaining appeal window.
Appeal deadlines vary by payer, plan type, state, and appeal level. Denial teams lose more recoverable revenue to expired deadlines than to lost appeals — and many of those expirations are cases that would have been overturned if someone had flagged the urgency.
The deadline flag is an estimated window based on standard commercial, Medicare Advantage, and Medicaid managed-care timelines for the relevant plan type and appeal level. It is not a guaranteed deadline — your team should verify the exact deadline with the payer or in the denial letter. But it ensures that urgent cases are identified at the suitability stage, before the window closes while the case sits in a queue.
Priority tagging: Cases with fewer than 14 estimated days remaining are flagged as urgent.
Turnaround: 24–48 hours. Available on individual cases and batch inventories. For high-volume screening, see the AR Audit specimen.
One suitable recovery can cover the pilot many times over.
$750 – $1,500
Three complex denials. Full Escalation Memo per case. Pattern summary included.
$8,000 – $50,000+
Medical-necessity denials on inpatient, DRG, post-acute, and specialty cases.
One recovery in three
One successful recovery among three reviewed cases may cover the pilot cost several times over.
3-Case Escalation Pilot
Send three complex denials. Receive a full Medical Necessity Escalation Memo for each, a short pattern summary, and credit toward your first monthly desk package if you continue.
Based on case complexity and whether U.S.-licensed reviewer sign-off is required.
What the pilot includes
- 3 selected complex denials reviewed by physician
- Full 12-section Medical Necessity Escalation Memo per case
- Appealability verdict for each case
- Denial-weakness analysis and criteria mapping
- Documentation-gap identification
- Short cross-case pattern summary
- Credit toward first monthly desk if you continue
The pilot is a paid structured evaluation — not a free sample. It is designed to prove that physician-level escalation reasoning improves your outcomes before you commit to a monthly package.
Monthly desk pricing is scoped after the pilot based on case type, turnaround requirements, volume, PHI workflow, and whether U.S.-licensed reviewer sign-off is required.
5 cases / month
Monthly pattern summary included. Entry tier for smaller denial teams testing the escalation model.
15 cases / month
Monthly denial-trend report included. For teams with regular clinical escalation volume.
30 cases / month
Escalation calls + ongoing policy intelligence. For anchor partners embedding the desk into workflow.
Pattern Audit
Quarterly denial-failure-pattern report. Sold standalone or bundled with any desk tier.
Prevention note on every memo
Every Escalation Memo includes a forward-looking operational note: what documentation practice, if adopted prospectively, would reduce the likelihood of this denial type recurring. Your physicians and CDI team receive improvement signals — not just appeal arguments.
Win/loss feedback loop
After your team submits the appeal, Clinovian follows up at 60–90 days to track the outcome. Over time, this builds payer-specific intelligence: which argument structures overturn, which payers respond to physician escalation, and where the methodology needs refinement.
Quarterly Impact Summary
A one-page summary your VP of Revenue Cycle takes to the CFO: cases screened, cases escalated, "do not pursue" savings, estimated recoverable revenue at stake, denial patterns identified, prevention notes issued. The desk builds its own renewal case.
| Deliverable | Normal turnaround |
|---|---|
| Appealability screen | 24–48 hours |
| Medical Necessity Escalation Memo | 48–72 hours |
| P2P prep brief | 24–48 hours |
| Complex DRG / level-of-care memo | 3–5 business days |
| AI Appeal Clinical QA | 24–48 hours |
| Monthly pattern summary | Monthly |
| Quarterly pattern audit | Quarterly |
| Quarterly Impact Summary | Quarterly (monthly desk clients) |
| Win/loss outcome follow-up | 60–90 days post-delivery |
Desk pricing, not hourly
Every engagement is priced by package, 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 memo. The work drives the price.
Licensure-transparent
Where U.S.-licensed clinical sign-off is required, the scope and cost reflect the panel reviewer engagement. Always disclosed upfront.
How the desk is scoped after 3 cases.
After the pilot, we review the engagement fit before proposing a monthly desk:
Case suitability
Are the escalated cases genuinely physician-level, or are most better handled inside your standard workflow?
Turnaround fit
Does the 48–72 hour memo cycle match your appeal-submission timelines?
Documentation quality
Is the clinical documentation sufficient for physician-level argument, or do cases consistently need records supplementation?
PHI workflow
Does the engagement require PHI transfer? If so, BAA and secure transfer are formalized before the desk begins.
U.S.-licensed support
Do any cases require formal U.S.-licensed clinical sign-off? If so, panel reviewer engagement is scoped and priced.
Volume and tier
Based on monthly case count and complexity, the appropriate desk tier — Starter, Growth, or Partner — is recommended.
This is why monthly pricing is scoped privately after the pilot rather than published. The variables above materially affect the engagement structure.
Start with a 3-case pilot.
Send three complex denials. Receive physician-grade escalation memos. Decide whether to continue.