We supply the evidence. You file.
We do one thing: find the coverage policy that governs a service — in the version in force today, with the date that version took effect — and either ground the argument in its text or say plainly that we cannot. Neither path ever touches patient data.
For practices
The authorization practice plan
Medicare requires prior authorization for procedures through WISeR in AZ, NJ, OH, OK, TX, WA, the hospital outpatient department program nationwide, and Medicare Advantage plan rules — and all three must apply Medicare’s coverage policy. Start with the free authorization check; the plan does the rest.
- 01
Check before you request
Procedure, diagnosis, state and setting. The authorization check names the program, the decision clock and route, the governing policy as it stands today, whether the diagnosis is on its list, the documentation its own text requires and, under WISeR, CMS's own documentation checklist for the service.
- 02
Save your practice; your codes are watched
State, usual setting and the codes you file. When a policy governing one of them changes, you hear about it.
- 03
Log each request by your own label
Straight from the check result, one at a time, or up to 500 at once by CSV — a label for the provider, never the NPI. The tracker counts each provider's decided requests toward the exemption the participant grants and shows the threshold where one is published. A weekly email gives each provider's standing and lists requests past their decision clock with no outcome recorded.
- 04
After a non-affirmation, resubmit with the policy
Choose what the non-affirmation said. A packet quotes the governing policy verbatim and states what the record must show, beside CMS's WISeR checklist where WISeR applies — or is refused, with the reason, when a coverage packet does not answer it.
$99 a month per practice (up to five providers) · $249 a month for groups and MSOs (up to 15) · larger groups, talk to us
Outgrow five providers and move to the group plan from your practice page; Stripe prorates the difference. Cancel any time from Manage billing. Nothing about a patient is ever entered.
For billing and revenue-cycle companies
Grounded appeal packets, per denial
For each Medicare Advantage denial, we find the coverage policy that binds the plan, state when its current version took effect, and return either a grounded appeal packet or an honest refusal. You keep the client relationship, the filing and the credit.
- 01
You send the denials
A five-column file: procedure code, diagnosis code, state, setting, date of service. It is read in your browser, and the dates of service never leave it: only the codes, state, setting and a count per combination reach us. Any other column refuses the file, so identifiers have nowhere to travel and no business-associate agreement is needed.
- 02
We run each one through the same check you can use for free
For each combination we find the coverage policy that binds the plan in that state — the national coverage determination, or the local contractor's determination and its billing article — the version in force and when it took effect, and whether the diagnosis is on the policy's covered list.
- 03
You get a packet, or a refusal, per denial
Each line is matched, in your browser, to the policy version in force on its date of service. A line in the version we hold gets a packet that quotes the policy verbatim, links the CMS document and states the regulatory basis for holding the plan to it. Any other line gets a refusal receipt naming the exact gap: the diagnosis not covered under that LCD on that date, or the earlier version that governed it. A refusal is never billed.
- 04
Your team files; the fee follows the recovery
The partner files the appeal under its own name and relationship with the practice. Terms follow the recovery and are set in conversation, not on a pricing page. Nothing is charged for a refusal.
Why a plan can be held to this
Under 42 CFR 422.101(b), a Medicare Advantage organization must comply with CMS’s national coverage determinations and with the written coverage decisions of the local Medicare contractor with jurisdiction for the area. Where Medicare’s coverage criteria are fully established, the plan may not apply criteria of its own that are more restrictive. That is why the policy text, as it stood on the date of service, is the evidence — and why we hold it as dated, versioned text rather than pointing at a page that may since have changed.
The regulation is the authority. Read it at eCFR §422.101.
What we never do
- We never say a claim is covered or a denial was wrong. We report what the policy lists and link the document.
- We never assert a code, a date or a coverage status that the policy's own text does not state. Where a link is our analysis rather than the document's text, it is labelled as analysis.
- We never render the absence of a policy as "not covered". Medicare may cover a service under general rules; we simply cannot point to a policy basis.
- We never touch patient data. Placeholders in a packet are merged by you, in your systems.
- We never give legal, billing or coding advice.
Start with the check.
Practices: run the free authorization check, then start the plan. Billing companies: send a denial file with the five columns above and we will return, per denial, what we can ground and what we cannot — before any commercial conversation.
Not legal, billing, or coding advice. The linked CMS documents are authoritative; this check only reports what they list.