Clinical categories where the outcome depends on the quality of the argument.
Specialty denials require specialty-specific evidence frameworks, society guidelines, and compendia grading — not generic medical-necessity narrative.
Oncology
NCCN category evidence, compendia grading, biologic access, step-therapy exceptions, and treatment-line documentation. Claims $15K–$80K+.
Cardiology
ACC/AHA guidelines, hemodynamic documentation, device-implant justification, and interventional-procedure authorization. Claims $20K–$150K+.
Orthopedics
Surgical necessity, failed-conservative-therapy documentation, imaging correlation, and post-acute rehabilitation justification. Claims $20K–$120K+.
Neurology
AAN guidelines, MS therapy access, rare neurological disease documentation, and neuromodulation authorization. Auth cycles $30K–$80K+.
Behavioral Health
Inpatient psychiatric, residential, PHP/IOP, and SUD program denials. Clinical necessity argument only — legal strategy and parity enforcement remain with client counsel.
Post-Acute
SNF, IRF, LTACH, and home health denials. Criteria-heavy, frequently disputed, and a category that has been specifically scrutinized in federal oversight reports for high appeal-overturn patterns.
Send a specialty denial for suitability review.
De-identified. 24–48 hour suitability verdict.