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Home The Desk Sample Work About
What We Handle · For Hospital Teams
Overview Medical-Necessity Escalation Memo Observation vs. Inpatient Defense DRG-Downgrade Challenge Peer-to-Peer Prep Brief Pre-Denial Necessity Dossier Specialty Clinical Denials
What We Handle · For Post-Acute
Overview Post-Acute Denials Overview SNF Denial Escalation IRF Denial Escalation LTACH Denial Escalation Home-Health Denial Escalation Concurrent Review Escalation
What We Handle · For RCM, IDR & AI
Overview AI Appeal Clinical QA RCM Partner Escalation No-PHI Clinical Denial AR Audit NSA/IDR Clinical Value Dossier Recurring Clinical Review Capacity
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Engagements & Pricing What We Take / Don't Take
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Why Clinovian Insights Field Guide: Six Failure Modes
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FAQ Security Contact Send a De-identified Case
About

A physician-led clinical escalation desk for denial and appeal operations.

Clinovian exists because there is a gap between what a coder, CDI specialist, or AI appeal tool can argue — and what requires genuine physician-level medical-necessity reasoning. That gap is the desk.

Leadership

Dr. Arun Kasturi, MBBS

Founder. Physician with payer-side utilization-management review experience across 3,000+ U.S. commercial claims under InterQual and MCG licensed criteria frameworks. The operational experience of applying criteria, constructing medical-necessity determinations, and evaluating clinical evidence from the review side is the foundation of the desk's criteria-mapping methodology — and what distinguishes the output from standard appeal narrative.

Additional background in pharmacovigilance (ICSR medical review, adverse-event assessment, aggregate safety reporting) and clinical-regulatory methodology — relevant to the desk's pattern-intelligence and AI appeal quality-assurance work.

Clinical review structure

The desk's clinical escalation methodology operates through a structured review process designed for consistency, quality, and licensure compliance:

01
Physician-led criteria mappingEvery case is reviewed by a physician with direct experience in how payer UM reviewers evaluate criteria. The clinical evidence is mapped to the denial rationale and the applicable criteria pathway — producing the argument structure, not just the clinical narrative.
02
Fixed-format deliverableThe output is a structured 12-section memo designed for handoff to the client's appeal writer or submission team. The format is consistent across all cases — eliminating variability and ensuring every section is addressed.
03
Pattern intelligence layerEvery case is tagged with denial-pattern metadata. Over time, the aggregate intelligence identifies payer-specific denial strategies, documentation gap patterns, and criteria-interpretation trends that feed back into both the desk's methodology and the client's operational improvement.

The output is clinical reasoning and criteria-mapped analysis — a work product for your team to use, not a licensed clinical opinion. Where a case requires formal U.S.-licensed sign-off, that determination stays with your own licensed clinical staff or designated reviewer.

How the practice operates

Physician-authored

Every escalation memo, P2P brief, and clinical QA review is authored by a physician — with coder, CDI, LNC, and AI workflows complemented rather than replaced.

Structured deliverables

Fixed-format outputs designed for handoff — your appeal writer receives the clinical argument, not a consulting memo they need to interpret.

Pattern intelligence

Every case feeds a proprietary denial-pattern library. Over time, the aggregate intelligence becomes as valuable as the individual memos.

Get started

The work speaks for itself.

Send a de-identified case. See the output. Then decide.

View Pricing View Sample Work
3,000+ Cases Reviewed
No PHI To Start
Fixed Scope · No Hourly Billing
BAA Before Records
Criteria-Mapped Logic