Medical Necessity for Health Systems & Hospitals
Increase overturned denials by leveraging our expertise in validating medical necessity.
Increase overturned denials by leveraging our expertise in validating medical necessity.
At Advent, we’re leaders in medical necessity reviews, not just appeal management.
Advent Health Partners’ clinical experts integrate seamlessly into your current team to overturn claim denials due to medical necessity or to fill gaps as needed. Our experts have 20+ years of clinical experience representing over 15 healthcare specialties. When claims are denied, we can determine the appeal viability of every claim placed, craft quality appeals, and follow-up until recovery.
Medical Necessity Validation In Numbers
According to a study published in HealthAffairs, over a five-year period, a large health plan denied approximately 1 in every 70 services under medical necessity rules, totaling hundreds of millions of dollars or approximately $60 per beneficiary.
Why Use Advent Health Partners?
Compelling Appeals
Our clinical team crafts compelling appeal packets and fields follow-ups to combat medical necessity denials. Our appeal letter structure is at the core of our 90+% appeal recovery rate. Writing an appeal is an art form, and crafting an organized and compelling appeal letter is key. Check out an example of a medical necessity appeal letter below to see our structure and best practices.
Reporting Package
Our reporting package includes detailed information on claim resolution, key metrics, and root cause analysis. Request our sample reporting package to see the types of analysis and recommendations we deliver. It comprises three key parts: the executive summary, the monthly status report, and an on-trend report. Learn more about our reporting package below.
Proprietary Appeal and Claim Technology
Our Apello technology platform was built by clinical, coding, and healthcare operational subject matter experts to increase claim review volume and accuracy. This technology, coupled with our team’s proven clinical and regulatory expertise, determines the viability of claims, crafts quality appeals, and follows-up appropriately for revenue recovery.
The Advent Health Partners Difference
Flexible Partnership
Advent flexes to your needs regarding services, admission types, and volume of cases.
Clinical Expertise
Our team of RNs have experience in several specialized fields.
Dedicated Onshore Experts
Advent’s team is 100% US-based and always available when needed.
Comprehensive Defense
Advent defends our work throughout the life of the claim—at no additional cost.
The Importance of Technology Solutions From Your Medical Necessity Partner
Technology has changed healthcare dramatically. When considering engaging a revenue integrity partner to increase overturned denials, their commitment to technology will be an asset to increasing revenue and validate medical necessity.
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