Clinical Appeal Services

Clinical appeals are cases that are denied as not medically necessary or experimental/investigational.

Our Clinicians will:

• Review the medical documentation
• Provide evidence from peer-reviewed medical literature that supports the medical necessity of the service or provide a summary of why the Clinician agrees with the denial (used for Physician education)
• Include a detailed timeline of the patient’s clinical events, supported by objective data like labs and vitals.
• Refer to physician notes and other direct documentation from the medical record to reinforce the diagnosis.