VCS Services & Pricing

Four tiers of nurse-led
authorization intelligence.

From routine workflow support to real-time payer analytics — VCS serves the full complexity spectrum. Every tier is nurse-led, payer-agnostic, and built to protect your revenue.

Use your portals. Keep your automation. Let VCS handle the complexity behind them. We are the human clinical and operational layer above fragmented payer systems — not a replacement for your technology stack.

Four Service Tiers

Built for the cases automation cannot solve.

Every tier includes SMART Model™ review and nurse-led oversight. Choose the level of clinical depth your caseload demands.

Tier 01
Authorization Operations Support
Workflow management for routine authorization coordination. Automation-compatible — designed to run alongside your existing tools.
Entry-Level
Per-case or monthly support pricing.
Contact for quote.
⚡ Entry Level
What's included
Portal submission & tracking
Payer status follow-up
Authorization expiration monitoring
Documentation coordination
Workflow intake management
Real-time status tracking portal
Submit a PA →

Routine cases.
Fast turnaround.

Tier 03
Denial Defense & Escalation
When a denial lands, VCS steps in — RN review, appeal packet preparation, peer-to-peer coordination, and overturn advocacy.
Premium
Premium pricing for appeals, P2P prep,
RN review & recovery work.
⚖️ Premium Tier
What's included
RN-led denial review
Appeal packet preparation
Payer escalation management
Peer-to-peer (P2P) preparation
Denial trend tracking
Overturn support & documentation
Post-denial documentation review
CARC/RARC code analysis
Defend a Denial →

Recovery-focused. Revenue protection-driven.

Tier 04
VCS Authorization Intelligence™
Ongoing payer analytics, denial trend reporting, SMART compliance scoring, and executive intelligence — delivered monthly.
Retainer
Monthly subscription model.
Custom quote by practice size.
📊 Analytics Subscription
What's included
Payer behavior tracking & reporting
Denial trend analytics (monthly)
Authorization aging reports
Overturn rate benchmarking
SMART Compliance Score (5-dimension)
Documentation gap analysis
Authorization expiration risk tracking
Executive dashboard & reporting
Request Intelligence →

Practice-wide analytics. Recurring insights.

VCS vs. Automation Tools

Automation can submit.
VCS interprets, escalates, defends, and protects.

IntelliPath, Availity, NaviNet, CoverMyMeds — these are tools VCS works alongside, not against. We are the clinical and operational layer above your payer technology stack.

Automation / Payer Portals
IntelliPath, Availity, NaviNet,
CoverMyMeds & Similar
Payer-connected workflow tools
Supports limited payer workflows
Handles straightforward submissions
May accelerate simple approvals
Does not provide independent clinical advocacy
Does not manage full denial defense
Does not provide payer-wide intelligence
No nurse-led review or escalation
No peer-to-peer preparation
VCS — The Human Layer
Veritas ClearPath Solutions
Nurse-led authorization operations partner
Payer-agnostic across all plans and portals
Nurse-led clinical review & documentation alignment
Denial defense and peer-to-peer preparation
SMART Model™ compliance and quality tracking
Payer behavior analytics and authorization intelligence
Provider-side operational support and revenue protection
Independent clinical advocacy — always on your side
Appeal management from denial through overturn

VCS does not compete with IntelliPath, Availity, NaviNet, CoverMyMeds, or payer portals. VCS is the human clinical and operational layer ABOVE fragmented payer systems — interpreting what the portals return, escalating what the portals can't, and defending what the portals let through.

Standard Across All Tiers

What every VCS engagement includes.

No add-ons for the basics. No surprises. These are the baseline deliverables on every authorization VCS touches.

🔬

SMART Model™ Review

5-dimension clinical scoring on every authorization — Specificity, Measurability, Achievability, Relevance, Timeliness.

👩‍⚕️

Nurse-Led Clinical Oversight

Every authorization touched by a licensed LPN or RN — not administrative staff. Clinical eyes on every submission.

📖

Payer Playbook Lookup

Real-time check against our payer-specific criteria database covering UHC, Aetna, BCBS, Cigna, Humana, and Medicare Advantage.

📄

Full Documentation Packet

Complete prior auth documentation assembled by nurse reviewers — no partial submissions that trigger automatic denials.

📊

Status Tracking Portal

Real-time status in your client portal — from intake through final determination, with stage timestamps and SLA tracking.

🛡️

Provider-Side Advocacy

VCS represents your practice's interests — not the payer's. We are your clinical and operational partner, not a payer tool.

VCS Authorization Intelligence™

Stop guessing at payer patterns.

Authorization Intelligence turns your case history into a strategic asset. Monthly reporting on payer behavior, denial trends, SMART compliance, and documentation gaps — so you're ahead of denials before they hit.

Monthly payer behavior & denial trend reports
Authorization aging & expiration risk tracking
Overturn rate benchmarking by payer & CPT
SMART Compliance Score (5-dimension, monthly)
Documentation gap analysis and recommendations
Executive dashboard with exportable reporting
Request Authorization Intelligence →
89%
First-Pass Approval
73%
Appeal Overturn Rate
7+
Major Payers Tracked
Book a Consultation

15 minutes. No pitch deck.
Real answers about your caseload.

Bring your top denial CPT codes and we'll give you a real quote — live, on the call. We'll tell you exactly which tier fits your practice and what the ROI looks like before you sign anything.