An embedded physician escalation desk for your denial operation.
Your team handles volume. Clinovian handles the clinical escalations your coders and appeal writers escalate — white-label or co-branded.
Your team handles denial volume well. The clinically hard cases stall.
Medical-necessity denials involving complex comorbidity arguments, level-of-care disputes, DRG downgrades, and criteria-interpretation challenges require physician-level reasoning that your coders and appeal writers are not expected to provide. Those cases either get under-argued, deprioritized, or stuck.
What you keep. What we provide.
You keep: the client relationship, the workflow, the submission, the credit. We provide: the physician-level clinical argument as a fixed-format memo your team uses to complete the appeal. White-label available — your brand, Clinovian's physician reasoning.
Route hard cases
Your team flags cases that exceed coder/appeal-writer scope. Send de-identified.
Suitability check
We confirm the case is suitable for physician escalation within 24–48 hours.
Memo delivered
Fixed-format Escalation Memo, 48–72 hours. Your appeal writer uses it directly.
Pattern reports
Monthly denial-trend intelligence across your escalated cases — payer, service line, rationale type.
Retain & grow
The pattern intelligence becomes a retention and upsell tool for your client relationships.
Best fit for partnership:
- → Denial-management firms
- → RCM firms with denial-management service lines
- → AI appeal / AI-RCM vendors
- → Utilization review consultants
- → Appeal-writing teams
Not the best fit:
- · General billing shops looking for low-dollar first-pass rework
- · Eligibility and benefits verification teams
- · High-volume, low-complexity denial processing
Start with a 3-case pilot from your caseload.
Send three cases your team has escalated. See the output before committing to a desk package.