CASE STUDY · CS-02
Notes vs. objective testing
80% obstruction claimed. Records showed 15% and 55%.
$388KTotal savings
PRE-SERVICE
Care AssurancePhysician-led prior authorization review
Specialty-matched physicians review care before it happens.
- Health plans & TPAs
- Employers
- Providers & ACOs
Discuss Care Assurance0.0003% OVERTURNED
PRIOR AUTHORIZATIONSLIVE
- PA-26-04817 · ORTHODetermined
- PA-26-04822 · CARDIOIn review
- PA-26-04830 · NEUROIn review
- PA-26-04833 · ONCReceived
The problem
Inappropriate care isn’t only futile. It’s often harmful.
Treatments that were right five years ago may not be best practice today.
Overview
What we do.
Care Assurance is Avandé’s physician-led prior authorization review. Board-certified, specialty-matched physicians check that requested care is necessary and follows current evidence, before it happens.
Key benefits
- Fewer unnecessary proceduresSPECIALTY-MATCHED REVIEW
- Decisions that hold up0.0003% OVERTURNED ON APPEAL
- Safer patientsCURRENT EVIDENCE-BASED CRITERIA
WHAT WE CATCH
- Care outside evidence-based guidelines
- Treatments built on outdated assumptions
- Excessive or duplicative testing
- High-cost care with no outcome gain
HOW IT WORKS
Four steps. One standard.
- Received
Step 01: Request received
- In review
Step 02: Specialty matched
- In review
Step 03: Physician review
- Determined
Step 04: Determination issued
EVERY STEP RUNS ON ANSERA PORTAL
Results
Measured, not promised.
0.0003%Decisions overturned on appeal
$0Balance billing
$1.4MEmployer A · one-year savings
Why Avandé
Care, not just claims.
Other vendors check the claim. Our physicians check the care, before it happens.
- SOC 2 Type II
- HIPAA
- BAA
- PHI Protection
| TYPICAL VENDOR | AVANDÉ |
|---|---|
| Reviews the claim | Reviews the clinical care |
| Validates coding | Validates medical necessity |
| Applies rules | Applies physician judgment |
| Accepts claims at face value | Verifies the documentation |
FAQ
Straight answers.
Rarely. 3 out of 10,000 cases (0.0003%) are overturned on appeal.
A board-certified physician in the same specialty as the requested care.
Evidence-based clinical guidelines, cited in every determination.
Yes. Specialty-matched physicians are available for peer-to-peer discussions.
Talk to a physician-led team
Discuss Care Assurance.
A few sentences are enough.