Clinical, Payer, and Provider Domain Acumen to Drive Savings
Our appeals analysis is guided by an experienced clinical talent pool of nurses located in the US, Philippines, and India, with US-licensed RNs supported by our innovation and technical experts. These blended-shore center of excellence resources deliver expertise at savings of 30%.
Our team has 15+ years of experience with payer clients (Medicare, Medicaid, Medicare Advantage, and commercial), including claims handling, member and provider customer service, eligibility, benefits, pharmacy, coding and clinical review, payment integrity, and payer clinical appeals handling and causes.
Our clinical teams have deep domain expertise in multiple clinical criteria, such as Medicare NCD/LCDs, MCG, InterQual, and clinical payer policies. We also bring 20+ years of provider revenue cycle management (RCM) experience supported by key insights into processing appeals and creating improvements. Our proven track record in effective appeals review determinations, prior authorizations handling, medical necessity review outcomes, and unique clinician development plans across geographies ensures standard decision and clinical knowledge enrichment.