As an Independent Review Organization (IRO), we can provide reviews for your appeals. All of our reviews are completed by board-certified physicians and specialists in compliance with your specific regulatory environment.
Our appeals reviews capabilities include inpatient/obs determinations, as well as:
- Outpatient services
- Inpatient services
- Home health
- Inpatient rehab
- Part B Pharmacy/Chemotherapy
- Genetic testing and pharmacogenomics
Our team has a track record of 5-star appeal uphold ratings.
When to use our Appeals Review Services
- Increased Volume
Maintain compliance for your appeals whether you’re receiving an increased number of appeals as an organization or within a particular service line.
- Added Expertise
Confidently deliver decisions and ensure that even your most complex appeals are reviewed according to the appropriate criteria and rationale.
- Demonstrate Objectivity
Even the smallest health plans can assure their members that their case has received an unbiased, objective, and criteria-based review.
How Cadenza can help with your Appeals
We guarantee that you’ll always receive appeals reviews that are evidence-based and appropriate for the regulatory environment. Our decisions will always provide the supporting rationale based on the criteria, and we can provide language for patient letters upon request.
Our team of board-certified physicians has extensive experience in a number of clinical settings and as medical directors in managed care and health plan settings. This experience enables us to bring the insight and care you need to even the most complicated cases.
We’re committed to maintaining processes to ensure that appeals are performed in an efficient manner without compromising accuracy or quality. We can work within your tight turnaround times, even on weekends and holidays, so that you can stay compliant and continue to serve your members.