Every case study below reflects a real engagement pattern — nurse-led clinical workflows, SMART Model™ documentation standards, and payer-specific defense intelligence deployed for specialty practices.
A 15-physician oncology infusion group was absorbing a 34% biologic denial rate with a 12-day average auth turnaround. Two FTEs spent the majority of their week on appeal documentation — and still lost 18% of appeals at initial reconsideration. Payer-specific clinical criteria for biologics and targeted therapies were inconsistently applied at submission, generating avoidable first-pass failures.
A 22-provider orthopedic and pain management group was processing 280+ prior authorizations per month across spine surgery, joint replacement, and injection procedures. A 28% denial rate on spinal injection and device auths — driven primarily by inadequate conservative treatment documentation — was delaying procedures and creating revenue unpredictability. Three admin staff were at capacity managing the volume, with no clinical review layer.
A 10-cardiologist multi-site practice was managing a 31% denial rate on cardiac imaging and interventional procedure authorizations — concentrated in Medicare Advantage plans, which had intensified review requirements over the prior 18 months. Cardiac catheterization, nuclear stress test, and echocardiography auths were failing medical necessity review at disproportionate rates, with appeals consuming an estimated 220 staff hours per month.
Enter your current volume and denial rate into our ROI Calculator to get a personalized projection — then book 15 minutes with our team to validate the numbers against your actual payer mix.